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Nasal Foreign Bodies
Nasal foreign bodies are usually encountered in children. However, occasionally they may occur in adults with mental retardation or psychiatric illness. Foreign bodies may be inorganic material such as plastic or metal. Examples include small parts of toys or even beads. These are sometimes discovered incidentally. Organic foreign bodies include wood, sponge, and food. They tend to irritate the nasal mucosa more and lead to earlier symptoms. Peas, beans, and nuts are among the more common organic foreign bodies. Males are more likely to insert foreign objects into their nose. Nasal foreign bodies including toys, building set pieces, coins, nails, screws, and batteries. In females, they tend to be jewelry and buttons. The average patient age is usually about 3 years.
Bleeding is commonly reported in patients with nasal foreign bodies, although it is not significant in nature. The foreign body itself may cause irritation to the lining, mucosal damage, and sometimes extension into adjacent structures. It can lead to septal perforation and cartilage necrosis. Unilateral foul-smelling nasal drainage in a child is a foreign body unless proved otherwise. A persistent foreign body can lead to sinusitis due to obstruction of the drainage pathways. Button batteries are very destructive and need to be removed within hours if possible to prevent chemical burns, ulceration, and severe damage within the nasal cavities. They cause destruction via low voltage electrical current and severe necrosis if the alkaline contents leak out. Damage can occur within hours and require immediate removal to prevent tissue destruction and complication. Sometimes foreign bodies can be displaced posteriorly and obstruct the nasal airway as well as lead to tracheal aspiration which is a serious situation. Nasal foreign bodies can sometimes be removed in the office in a cooperative patient. If not, the procedure would need to be performed under general anesthesia. Read more
Two bands of muscles constitute the vocal cords. They vibrate to create sound arising from the larynx. Hoarseness can arise from various etiologies. Excessive voice abuse such as talking too much, screaming, or repeated throat clearing can create irritant laryngitis with thickening along the edges of the true vocal cords (callouses of the vocal fold). These may occur on both sides of the vocal cords facing each other and leading to poor approximation of the free edges. The condition may progress to a nodule or polyp. Symptoms of vocal cord lesions include vocal fatigue, low-pitch gravely voice, breathy voice, inability to sing high notes, rough voice quality, frequent throat clearing, and voice breaks. Treatment usually constitutes speech therapy and video stroboscopy. Further options include removal of the nodule or polyp under general anesthesia if there is no significant improvement with medical treatment. Other causes of hoarseness include an upper respiratory tract infection with irritant laryngitis. Reflux can also irritate the larynx and contribute to hoarseness. Sometimes a tumor may develop over the vocal cords especially in smokers. Paralysis of the vocal cord can occur following and upper respiratory tract infection, surgery, trauma, or cancer within the neck or chest.
If hoarseness persists for more than 2 or 3 weeks, especially in smokers, it is critical to have the larynx checked by an ear, nose, and throat specialist, especially to rule out any serious anomaly. The otolaryngologist will examine the vocal cords and often use a scope or strobe light to assess the vocal fold vibration and movement. Treatment is based on the specific etiology causing voice disorder. Most of the conditions can be successfully treated if identified and diagnosed early. Read more
Dizziness and Vertigo
Dizziness and vertigo are common symptoms reported during office visits. They can result from an inner ear peripheral vestibular disorder or a central vestibular disorder involving the brain. It is important to differentiate the between them so as to make an accurate diagnosis and recommend appropriate treatment. Dizziness is a sensation of feeling faint, unsteady, or being lightheaded. Vertigo is more specific and refers to a frank spinning rotational perception of movement.
Vestibular dysfunction can be caused by head injury, aging, viral inflammation, autoimmune disease, loose crystals within the inner ear, etc. Below is a short list with appropriate description: Read more
Sudden Hearing Loss
The incidence of sudden sensorineural hearing loss is 1 per 5000 every year. This refers to nerve damage versus an ear infection with middle ear fluid. It is likely to strike adults in their 40s and 50s, although we have seen it in much younger and older individuals. Audiogram will usually reveal a 30 dB loss in 3 continuous frequencies that is sensorineural in nature. It is usually unexplained, although sometimes related to a viral upper respiratory tract infection, vascular disease, ototoxic drugs, brain tumor, autoimmune disease, or Meniere’s disease.
Ear exam is normal with no middle ear fluid or infection apparent. Patients typically wake up with this one morning or notice it over the day when they are trying to use the phone.
Sometimes patients may notice a loud pop before the hearing diminishes. Patients with sudden hearing loss may also become dizzy with tinnitus (ringing/roaring/chirping sounds). If this were to occur, one would suspect underlying Meniere’s disease as well. Read more