ENT & Cochlear Implant

Glossopharyngeal neuralgia is a rare medical condition characterised by repeated episodes of sharp or shooting pain in the ears, tongue, throat, or tonsils. This pain lasts from a few seconds to a few minutes. Associated Anatomy of Glossopharyngeal Neuralgia The ears, tongue, tonsils, or throat Glossopharyngeal Neuralgia Causes While the exact cause behind glossopharyngeal neuralgia is unknown, studies indicate the following factors may lead to the development of the condition. Blood vessels pressing on the glossopharyngeal nerve. Infections or tumours at the base of the skull. Medical diseases, such as Sjorgen’s disease, multiple sclerosis, and Eagle’s syndrome. Cancer or infection in the mouth and tonsils. Intracranial lesions. Glossopharyngeal Neuralgia Symptoms Glossopharyngeal neuralgia is characterised by a sharp or stabbing pain on one or both sides. It causes pain in the areas connected to the glossopharyngeal nerve, such as: Back of the tongue Voicebox (larynx) Throat Tonsils Ears Back of the throat and nose (nasopharynx) In severe episodes, it can result in symptoms such as: Syncope (fainting) Arrhythmia (irregular heartbeat) Bradycardia (slow heartbeat) The episodes of pain recur several times during the day and can disrupt an individual’s sleep. The following factors may trigger this condition. Chewing Coughing Sneezing Yawning Cold beverages Laughing Speaking Touching a blunt object to one’s tonsils. Stages of Glossopharyngeal Neuralgia The glossopharyngeal neuralgia nerve starts at the lower end of the brain stem and ends deep in the throat. As a result, the pain radiates across the tonsils, throat, tongue, and ears. While it is commonly observed on one side, the pain can spread to the other side as well. Glossopharyngeal Neuralgia Diagnosis The doctor will conduct a detailed physical examination and collect your medical history to get a better understanding of your health. For proper diagnosis, your doctor may recommend one of the following tests. Blood tests A battery of blood tests is conducted to rule out possible infections. Imaging tests Your doctor may recommend a CT scan or an MRI to get a detailed image of the head to see if any tumour or blood vessel is pressing on the nerve. Glossopharyngeal Neuralgia Treatment Depending on the severity of the pain, your doctor may recommend the following glossopharyngeal neuralgia treatments. Medications In most cases, anticonvulsants and antidepressants are prescribed as the first line of treatment to manage the pain and depression associated with the condition. Surgery In severe cases, doctors opt for surgical procedures when medications fail to provide relief. Surgical procedures such as microvascular decompression are conducted where a Teflon sponge is put between the glossopharyngeal nerve and the compressed vessel to relieve the pain. Risk Factors of Glossopharyngeal Neuralgia Since the exact cause behind glossopharyngeal neuralgia is unknown, studies suggest that the following factors may increase the risk of developing this condition. Individuals over 50 years of age Cervical or vascular malformations Injury to the base of the skull Autoimmune diseases Multiple sclerosis Structural abnormalities caused by facial lesions Complications of Glossopharyngeal Neuralgia Glossopharyngeal neuralgia may result in possible health complications. These include Syncope (fainting) Arrhythmia (irregular heartbeats) Bradycardia (slow heartbeat) Hypotension (low blood pressure) Seizures Weight loss Difficulty swallowing Difficulty speaking Damage to the carotid artery Hypoperfusion (reduced blood flow) Cerebral hypoxia (less oxygen in the brain). In rare cases, one might experience side effects of the prescribed medications. Glossopharyngeal Neuralgia Prevention Primary Prevention of Glossopharyngeal Neuralgia Since the exact cause behind glossopharyngeal neuralgia is unknown, currently there are no medical strategies that can be used to prevent the development of the condition. If you experience sharp or stabbing pain in the tongue, tonsils, throat, or ears, consult a doctor immediately to get the right treatment. Secondary Prevention of Glossopharyngeal Neuralgia Doctors may use the following treatment options to manage the condition. Anticonvulsant or local anaesthetics to provide relief. If the medications fail to do so, doctors go for surgical interventions such as microvascular decompressions to provide long-term relief from the pain. Ensure that you follow the doctor’s instructions and go to follow-up appointments to track the progress of the condition. Epidemiology of Glossopharyngeal Neuralgia Studies suggest that glossopharyngeal neuralgia is a rare medical condition observed in: Individuals over the age of 50 1 in 100,000 people every year It is equally seen in both males and females 74% of patients have spontaneous remissions 12% of the patients experience bilateral pain The annual recurrence rate is low as 3.6%. Expected Prognosis of Glossopharyngeal Neuralgia The prognosis of individuals with glossopharyngeal neuralgia depends on the possible cause behind the condition and their response to treatment. While some people respond very well to medications, some may require surgical interventions. Multiple episodes of severe pain accompanied by bilateral pain are poor prognostic indicators. Natural Progression of Glossopharyngeal Neuralgia Glossopharyngeal neuralgia can start in your throat and spread to your tonsils, tongue, and ears. While it is commonly observed on one side, it can spread to the other side as well. Severe pain can result in difficulty swallowing, loss of appetite and weight loss. Pathophysiology of Glossopharyngeal Neuralgia The glossopharyngeal neuralgia is located at the base of the stem, which moves along with the vagus nerve passing the internal jugular vein to the base of the tonsils, tongue, and glands of the mouth. The activation of the vagus and glossopharyngeal nerves can result in pain, fainting, and irregular heartbeats.

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Nasal congestion happens when the tissues in the nasal passages get inflamed with excess fluid and mucus. This triggers irritation in the nasal passage and difficulty in breathing through the nose. It may occur due to an infection, or external factors, such as allergies, smoke, or chemical fumes. Alternate Name of Nasal Congestion Nasal blockage or stuffy nose Associated Anatomy of Nasal Congestion The nose Nasal Congestion Causes Nasal congestion is caused due to inflammation in the nose. If this happens due to an infection, a cold or flu, it clears up in a week or two. But, if the congestion lasts for more than two weeks, it could be due to some underlying health issue. The causes of nasal congestion are: Allergies Chemical exposure Environmental irritants Chronic sinusitis Sinonasal tumours Hay fever Nasal polyps or non-cancerous growths in the nasal passages Enlarged adenoids Gastroesophageal reflux disease Hormonal changes Sleep apnea Thyroid disorders Occupational asthma Nasal Congestion Symptoms The symptoms of nasal congestion are: Trouble breathing through the nose Watery nasal discharge Itchy eyes, nose, mouth, and throat Sneezing Sore throat Cough Bad breath Runny or stuffy nose Nosebleed Loss of smell or taste Watery eyes Pain in the ears Headache Fever Fatigue Bodyache Nasal Congestion Diagnosis Doctors assess your symptoms by checking your nose, ears, and throat. To rule out other health conditions, doctors advise a throat culture to check for specific bacteria in the throat. Suppose the congestion doesn't clear even after 10 days. In that case, doctors may recommend a CT scan to check for any obstacles in the nose and nasal endoscopy to look inside the nose for any abnormalities. Differential Diagnosis of Nasal Congestion The differential diagnosis for nasal congestion is rhinitis or inflammation caused by viral or bacterial infection, nasal polyps, nasal valve disorder, reaction to medications, such as NSAIDs and aspirin, and structural changes in the nasal septum.  Conditions such as collagen vascular disease, vasomotor rhinitis or inflammation of tissues in the nasal passages, and other nasal diseases are some of the other differential diagnoses for nasal congestion. Nasal Congestion Treatment Doctors usually prescribe medications to treat symptoms of nasal congestion, such as: Oral antihistamines to treat the allergies Saline sprays to moisturise the nasal passages Corticosteroid nasal sprays to give relief from inflammation Prescription nasal decongestants, such as nasal sprays and nasal drops to relieve the nose of stuffiness. Risk Factors of Nasal Congestion The risk factors of nasal congestion are: Common cold Allergens, such as pollen, dust mites, pet dander, and mould Spicy foods Alcohol consumption Cigarette smoking Inhaling industrial smoke Fumes of harmful chemicals Inhaling hot and dry air Asthma Certain medications used to treat seizures and blood pressure. Possible Complication of Nasal Congestion If left untreated, nasal congestion can cause irritation and discomfort for adults and older children. It can affect children's sleep and disturb infants' feeding times. Furthermore, nasal congestion can cause serious issues, like sinusitis, middle ear infection, nasal polyps or small, non-cancerous growths in the nasal passages. Nasal Congestion Preventions Primary Prevention of Nasal Congestion Practising the following will help reduce the risk of infection and nasal congestion due to allergens: Washing hands with soap and water Avoiding contact with people who are sick Frequent vacuuming Changing bed covers regularly Keeping windows and doors closed during pollen seasons Staying away from furry animals if you are allergic to pet dander Secondary Prevention of Nasal Congestion Recurrence of nasal congestion can be avoided by: Managing allergies and asthma by following a treatment plan. Avoiding inhalation of airborne substances such as cigarette smoke, chemical fumes, dust, and allergens that can irritate the nasal passages and cause congestion. Using a humidifier at home helps moisten the nasal passage, improves the flow of mucus, and prevents nasal blockages. Using a nasal rinse, like a saline spray, to rinse the nasal passages and improve the mucus flow. Regularly washing hands with soap and water, especially after returning from outdoors. This helps prevent bacterial and viral infections. Epidemiology of Nasal Congestion Nasal congestion is a common condition and is caused either due to allergies or infections, such as the common cold and seasonal flu. Some people are at higher risk of nasal congestion. Age: Children and adults are both affected by nasal congestion Gender: Men and women are both prone to nasal congestion Season: Those allergic to pollen and seasonal changes get nasal congestion. Occupation: People exposed to smoke, paint fumes, and spicy foods Allergies: Those allergic to pet dander, mould, and dust mites. Expected Prognosis of Nasal Congestion Usually, nasal congestion lasts for six to seven days. It is accompanied by a runny nose due to the mucus flowing from the nose, causing difficulty in breathing from the nose. People also experience headaches, coughing and sneezing. However, if the congestion lasts longer than a week, it could indicate an infection. Natural Progression of Nasal Congestion Nasal congestion is a common occurrence. Although there is no cure for the condition, you can try home remedies or over-the-counter medications to relieve its symptoms. The congestion causes inflammation or swelling in the nasal passages' inner lining, followed by excess mucus production and flow. However, in a few days, the congestion clears, and you get relief from a runny nose. Pathophysiology of Nasal Congestion Pathophysiology of nasal congestion includes mucosal inflammation, increased nasal secretion, swelling of the nasal tissues, dilation of blood vessels in the nose, and change in smell and taste. 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The thyroid is a butterfly-shaped hormonal gland residing at the base of the throat. The organ has two sides called lobes situated on both sides of the windpipe and connected by tissue. Thyroid lobectomy removes one of the lobes of the thyroid gland. The lobectomy is conducted in the following circumstances: Thyroiditis: Inflammation of the thyroid gland. Thyroid Nodules: Lumps formed on the gland may be cancerous or benign. Follicular Adenoma: Benign tumour on the thyroid gland. Goitre: Enlargement of the thyroid gland. Alternate Name of Thyroid Lobectomy Hemi-thyroidectomy Body Location of Thyroid Lobectomy The front base of the neck Thyroid Lobectomy Procedure Type Surgical Preparation for the Thyroid Lobectomy Procedure The pre-operative steps for a thyroid lobectomy are as follows: Physical Examination Your doctor will physically examine you and check for symptoms. Diagnostic Tests CT scans and ultrasounds will be conducted to identify the problem. Fine Needle Biopsy If nodules are discovered in testing, a fine needle biopsy will be conducted to extract fluid to determine whether the nodules are cancerous or benign. Vocal Cord Checking The doctor will check your vocal cord function to determine if they are affected. Medication and Therapy Till the procedure is scheduled, thyroid-regulating medications are given to control the excess thyroid hormones. Medical History Your previous medical conditions and medications will be recorded. If you smoke or drink, discuss with your doctor about the same. You will have to avoid taking blood-thinning medicines. Before Surgery You will be required to fast and avoid drinking water, except for taking necessary medicines, eight hours before surgery. How is the Thyroid Lobectomy Procedure Performed? The thyroid lobectomy procedure begins with general anaesthesia and the insertion of an endotracheal tube through the mouth or nose. You will be laid flat on your back, with sandbags placed under the shoulder blades. This ensures the extension of the neck and makes the surgical area more prominent. After the surgical area is disinfected, a horizontal incision is made along the natural crease of the neck. The tissue and muscles surrounding the thyroid gland are drawn back, and the lobe that has to be removed is lifted away from the parathyroid gland and the recurrent laryngeal nerve (RLN). Parathyroid glands are rice grain-sized organs located behind the thyroid organ. The nerve is associated with the functioning of some muscles in the larynx, also known as the voice box. The recurrent laryngeal nerve and the parathyroid glands are close to the thyroid glands and, therefore, at risk of injury or damage. The intended lobe is removed, and the muscles are strapped back into position. A drain tube is inserted to remove fluids from the operation site. The incision is closed with sutures. Follow up After Thyroid Lobectomy Surgery Your doctor will provide you with post-operative care instructions. Follow-up instructions involve taking care of the incisions and the dressing. Keep the area clean and dry, and leave the dressing in place unless instructed otherwise. Avoid scratching the area around the stitches. Avoid strenuous physical activities for two weeks following the surgery. Use pillows while sleeping to keep your head elevated. You can do light activities a day after the procedure and return to your regular schedule after two weeks. Avoid driving till you are unable to move your neck freely. You can consume light food and liquids in the initial days, although there are no dietary restrictions. You can also resume your daily medications after consulting your doctor. Certain medications need to be avoided as they may cause bleeding. Ask your doctor to prescribe pain relief medicines. Thyroid lobectomy only removes one of the lobes of the thyroid gland. Therefore, additional thyroid supplements may not be necessary. However, check your thyroid levels six to eight weeks after the procedure to ensure the remaining half is functioning correctly and producing adequate hormones. The doctor will give you supplements if the thyroid levels are not balanced. Risks Associated with Thyroid Lobectomy Surgery The risks associated with thyroid lobectomy are as follows: Bleeding: Bleeding may occur post-surgery at the incision site, leading to respiratory complications. Scarring: The incision is made in the neck's natural crease to reduce the scar's appearance. However, there might be some scarring after the healing of the stitches. Injury to the recurrent laryngeal nerve (RLN): The nerve is close to the thyroid gland and, therefore, is at a higher risk of injury. Damage to the nerve may lead to a temporary or permanent change in your vocal chord, like your voice becoming hoarse. Recovery After Thyroid Lobectomy Surgery The procedure for thyroid lobectomy takes around 1 to 2 hours. After the patient is shifted to the recovery room, vitals and breathing are monitored. Thyroid lobectomy is an outpatient procedure. Most patients are discharged on the same day after the effects of the anaesthesia wear off, and the doctor has completed the check-up. However, you may be asked to remain for a day to observe any post-surgery complications. You will have a sore throat due to the insertion of the endotracheal tube; this will subside after a few days. The incision is secured with self-dissolving sutures and heals quickly. The scar fades over time and is barely visible. You might experience tightness in the neck after the procedure, but the sensation subsides with the help of light stretching and neck exercises. You can undertake light activity from the next day of the procedure and go back to your regular daily routine after two weeks. The duration of recovery may vary from person to person depending on their health, the reason for the procedure, age, previous medical problems, and their response to the treatment.

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Turbinate surgery or turbinate reduction is a minimally invasive procedure performed by ear, nose, and throat (ENT) specialists to reduce nasal obstructions. Doctors opt for turbinate surgery when alternative treatments, such as nasal steroids or antihistamines, fail. Turbinates are bony structures in the inner side of the nasal cavity surrounded by vascular tissue and a mucous layer. They cleanse and help add moisture to the air as they enter through the nostrils. Prolonged allergies or colds can cause inflammation of the tissues, which may result in breathing difficulties in individuals. The surgery removes or shrinks extra tissue from the turbinates that helps clear the passageway. It helps alleviate the following conditions: Deviated septum Snoring Severe allergic issues Chronic swelling of the turbinates (hypertrophy) Sleep apnea-related health issues. Alternate Name of Turbinate Surgery Turbinectomy / Turbinoplasty / Radiofrequency ablation Where are the Turbinates Located? The turbinates are in the lateral walls of the nasal cavity. There are three pairs: superior, middle, and inferior. Turbinate Procedure Type Minimally invasive, surgical procedure. How to Prepare for the Turbinate Surgery Procedure? Turbinate reduction/removal requires minimal preparation. Before the procedure, follow the instructions of the medical practitioners. You may require to stop eating at a specific time before the surgery starts. It is safe to inform the doctor whether you are pregnant or have any pre-existing medical condition that may interfere with the treatment outcome. Additionally, you may need blood work done. The doctor determines the need based on your medical history. You should also give a detailed chart of the medications you take. For instance, before such procedures, the doctors may advise you to refrain from taking blood thinners such as aspirin or ibuprofen as they may affect the blood clotting process. All the instructions are given to the patients beforehand. Make sure to follow through thoroughly. How is Turbinate Surgery Performed? Turbinate surgery is a short-term procedure, and the patient can be discharged on the same day. The specialist usually uses general anaesthesia or local anaesthesia so that the patient does not experience any pain. If the patient's condition is less severe, doctors may opt for turbinate reduction instead of removing it. For instance, turbinoplasty uses the out fracture technique, where a surgeon places equipment inside the nostril to change the position of the turbinates. Another method is radiofrequency ablation, where narrow, flexible equipment is placed inside the nostril. Radiofrequency energy passes through this equipment, shrinking the tissue. In severe cases, doctors opt for turbinectomy. They use a narrow probe with a lighted camera at the tip that is inserted into the nostril. Next, they shave off the lower turbinate entirely or partially, using a microdebrider. Follow up After Turbinate Surgery The surgery itself takes anywhere between thirty minutes to an hour. After the surgery, you are usually observed for a couple of hours. During this time, the doctors look for any reaction or complication that may arise. Following this, you are discharged. As the turbinates heal, you may experience mucous discharge that may result in crusting. Humidifiers or Vaseline help keep the insides of the nostrils moist. Apart from this, the doctor prescribes pain medications, as well as medicines for other side effects that may appear at a later time. The side effects of this procedure are mostly minor. They can be dizziness, nausea and vomiting, all of which can be managed effectively at home. However, you must visit the doctor in case the symptoms increase in severity, or you get a fever, have difficulty breathing, or experience heavy bleeding after getting discharged. What are the Risks Involved in Turbinate Surgery? As with all medical procedures, there are certain risks involved in turbinate surgeries. They are as follows: In rare cases, you may develop empty nose syndrome, where you cannot feel the air passing through the nasal passage. You may experience nosebleeds. You may experience nasal dryness. Before the surgery, the medical practitioners will discuss all the risks and only recommend the procedure if it is right for you. Recovery After Turbinate Surgery As already mentioned, you may go home on the day of the surgery if there are no post-surgical complications. The total healing period for this surgical procedure is around two months. The practitioners monitor the patient throughout their healing period. The patient may experience discomfort for the first two to three days after the surgery. The insides of the nostrils may remain swollen for some time, and the patient may continue to experience a nasal blockage. However, the swelling goes down to a large extent within a week. After the two-week mark, patients can resume normal activities. The overall success rate of the surgery is 82%. The prognosis of this procedure is satisfactory. For instance, most patients undergoing turbinoplasty with a microdebrider can go almost three years with no symptoms of nasal blockage. When surgically removed, the turbinates usually do not grow back. In the rare cases that they do, the patient may need to undergo a second round of surgery to reduce their size.

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