In a nutshell... common ENT conditions.

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What?  Can you repeat that…  Sound, after being captured by the ear lobe [pinna] travels along the external ear canal to reach the tympanic membrane [ear drum]. The sound wave is then passed on via the tiny middle ear bones to the inner ear where the sound wave literally is converted into an electrical impulse and then sent to the brain via an intricate nerve system in the brain stem. Hearing loss thus can be divided into two major categories: conductive: where there is an obstacle in sound conduction and sensori-neural, where the inner ear has difficulty to convert the sound wave into an electrical impulse. A hearing test [audiogram] will facilitate the correct diagnosis. The rule of thumb is that many conductive conditions can be corrected surgically, but when the nerve component is involved, amplification [hearing aid] might be indicated.

What is that noise in my head…  Tinnitus comes from the Greek word meaning ‘noise’. This noise or sound is perceived in the ears or sometimes in the head. We again divide tinnitus into 2 groups: pulsating [or vibrating] and non-pulsating [or non-vibrating]. Pulsating tinnitus many a time is caused by increased / abnormal blood flow - be it due to inflammation in the ear [infection], abnormalities of blood vessels [aneurisms or blockages] and even vascular growths in the middle ear or temporal bone. A special variation can also be caused by spasm of the tiny muscles in the middle ear.  Non-pulsating tinnitus mainly is generated in the inner ear / nerves in the brain stem and often accompanies hearing loss. It also might be an early tell tale of inner ear damage – manifesting prior to hearing loss ensuing. Degenerative conditions of the cervical spine might also cause tinnitus.  Treatment of pulsating tinnitus might be surgical – depending on the cause. Non-pulsating tinnitus is a frustrating condition and often challenging to manage – sound exposure [masking] remains the cornerstone of treatment.

Every time I turn around, I must hold on…  Maintenance of balance is a complex physiological act and in more than one aspect reminds one of the intricacies of the art of flying. The ability to maintain balance depends on the function of 3 systems: eyes, ears and proprioception (awareness of position of the body). Messages from these systems allow us to orientate in space. But the plot thickens in that these messages must be integrated and refined by the cerebellum and the brain which then facilitates appropriate motor activity to allow ‘the next move’. Disruption anywhere in this chain will literally ‘throw’ us.  Clinically, balance disturbance wears many jackets: it can present acutely or come on insidiously, it could manifest with a crippling sense of spinning (vertigo), or more subtle unsteadiness, unsure footedness, or vague imbalance or spatial disorientation. It also could be positioning related (or non-related) and could last from seconds up to days but at times also can become chronic – a lifelong sentence.  The management of balance disturbance encompasses measures to confirm the diagnosis and then negotiate / alleviate the acute situation and eventually to concentrate on rehabilitation and to address a chronic state, should it occur.  Various role players are involved in the management process: family physicians, ENTs, neurologists, neuro ophthalmologists / optometrists and (vestibular trained) physio therapists, audiologists and at times even psychologists.  

It's my sinuses...  The nose is an interesting character: not only does it allow breathing, but it also meticulously prepares the air by heating, humidifying, and cleaning it. And considering that we shift 2L of air every minute this is no light task. It also permits smelling [and thereby facilitates tasting]. The [paranasal] sinuses are air filled cavities in the facial bones that communicate with the nose via tiny windows. Various conditions can negatively impact sinu-nasal function: anatomical variations [e.g. septal deviation], inflammatory conditions [allergies], infections [be it viral, bacterial or fungal], destructive diseases and even cancer. Aging also influences nasal function and the nose can be affected by various medications. None of the above conditions is privy to a set of exclusive symptoms – decreased airflow, excessive postnasal discharge, a runny nose, impaired sense of smell, blood stained secretions and even facial fullness and pain can be caused by any of the above.  Careful examination [clinical/radiological/hematological] thus is imperative to make a decent diagnosis and facilitate treatment.

Can you just take them out…  The tonsils and adenoid are larger aggregates of lymphoid tissue found in the throat and back of the nose respectively. Together with numerous smaller clusters of lymphoid tissue in the upper airway and digestive tract, they fulfill a basic immunologic function. The main indications for adenotonsillectomy are recurrent / chronic infections, enlargement [resulting in airway obstruction] and to obtain tissue for pathological analysis [in case of a suspicion of cancer].  Although adenotonsillectomy is a common and safe procedure, the post-operative time is by no means a walk in a rose garden: patients experience significant pain and there even is a risk of bleeding, that might be life threatening, if neglected. It speaks for itself that we should respect indications when considering a surgical solution.

Me horse pills get stuck…  The act of swallowing is a well-coordinated complex chain of muscle actions that are partly voluntary and partly involuntary – indeed a well-tuned machine. The food bolus must be pushed from the mouth to the throat and then down to the swallowing pipe [esophagus] without going up the nose or entering the windpipe along the way. Dysphagia [or a disruption of the swallowing process] results when smooth passage of the bolus is disturbed.  This could be due to a physical obstruction of the tract [due to a growth] or a disruption of muscle function which can be caused by neuromuscular conditions [degenerative diseases, post stroke], loss of function due to surgery or radiation and even the aging process. Careful clinical examination [which might incorporate a visual swallowing study] as well as radiological studies usually facilitates a diagnosis and permits treatment / rehabilitation.  

The elephant in the room…  We many a time think of snoring as a mere nuisance and something to make fun of. However, it can be a harbinger of something potentially serious, particularly if associated with episodes of cessation of breathing [also known as apnea]. Sleep apnoea not only results in unrestful sleep and subsequent excessive daytime sleepiness but also potentially negatively impacts quality of life on a much broader range – e.g. cognitive function. To boot, it might have dire other health risks by causing heart and lung disease and even expose patients to suffer a stroke. Although positive airway pressure [CPAP] is the mainstay of treatment, some patients might benefit from surgery. Weight loss is a sine qua non in the overweight patient.

ENT surgeon: Dr LP de Jager - Website by Evolve Medical
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