Nose Bleeds

What Causes a Nosebleed?

The linings of the nose are rich in blood vessels. Nose bleeds occur whenever there is a disruption in the linings of the blood vessels causing the small blood vessels to burst and cause nasal bleeding. Nose bleeds can be due to simple causes like drying and crusting of the nose or due to high blood pressure, frequent nose-picking, injury to nose and sometimes, due to tumors in the nose.


What Are My Treatment Options?

If you are suffering from a nose bleed, immediately place ice cubes on the nose and pinch your nostrils tightly for 6- 8 minutes. This can stop bleeding. Sit upright in a situation with nose bleed to prevent swallowing of blood and blood entering your air passages.

If the nosebleeds persist, reach the hospital immediately. Your check–up will reveal whether the bleeding is due to injury to the nose or due to high blood pressure causing bursting of the blood vessels in the nose. You may be given pressure dressings in the nose to stop the bleeding and medications.

Persistent bleeders require endoscopic examination of the nose for identifying the cause of the bleeding.
Using an endoscope, a thin 4 mm device with a camera for seeing inside the nose, your ENT surgeon will identify the source of bleeding and do cauterization (sealing) of the blood vessel that is causing the trouble.

Can I prevent re-bleeding? 

Avoid blowing the nose vigorously. Take your medications properly. Have a regular check on your blood pressure if you are detected with high blood pressure. Never pick your nose with your finger or any other object. Keep your nose moist using Vaseline or any other ointment as prescribed by your doctor.

What surgeries we do?

1 Adenoidectomy
2 Adenotonsillectomy
3 Adenotonsillectomy with bilateral grommet Insertion
4 Aural Polypectomy
5 Biopsy - Minor
6 Caldwell – Luc Surgery
7 Cauterisation - Chemical
8 Cauterisation of Nasal Bleeding - Endoscopic
9 Cautery Patching Ear (Unilateral)
10 Choanal Atresia
11 Commando’s Operation
12 Conservative Surgery for Ca Larynx
13 Cyst & Benign Tumor of Palate
14 Decompression of Endolymphathic Sac
15 Dental Cyst & Tumor Excision
16 Direct Laryngoscopy /Biopsy
17 Drainage - Any Abscess
18 Drainage of Parapharyngeal Abscess - External
19 Drainage of Retro-pharyngeal abscess
20 Ear Lobule Repair - Bilateral
21 Ear Lobule Repair - Unilateral
22 Endoscopic CSF Fistula Repair
23 Endoscopic DCR
24 Endoscopic Optic Nerve Depression
25 Endoscopic Orbital Decompression
26 Endoscopic Transsphenoidal Hypophysectomy
27 Epley's Maneuver
28 Examination under Microscope
29 Excision of Acoustic Neuroma
30 Excision of Angiofibroma
31 Excision of Angiofibroma (Extensive)
32 Excision of Brachial Cyst and Sinus
33 Excision of Cystic Hygroma
34 Excision of Glomus- jugulare Tumor
35 Excision of Plunging Ranula
36 Excision of Thyroglossal Cyst or Sinus
37 Excision of Tumour - External Auditory Canal
38 External Ethmoidectomy - Unilateral
39 Foreign body Removal Ear / Nose
40 Foreign body Removal / biopsy by Rigid Bronchoscopy
41 Foreign body Removal / biopsy by Rigid Oesophagoscopy
42 Foreign body Removal Cricopharynx
43 Facial Nerve Decompression Vertical or / and Tympanic Segment
44 Facial Nerve Decompression with Nerve Graft
45 Facial Wound Repair
46 Facial Wound Repair (Major)
47 FESS – Complicated
48 FESS - Extensive
49 FESS – Minor ( Bilateral)
50 FESS – Minor ( Unilateral)
51 Fibreoptic Bronchoscopy under LA (Diagnostic)
52 Fibreoptic Bronchoscopy with FB Removal/Biopsy
53 Fibreoptic Laryngoscopy
54 Fracture Mandible Repair & Plating
55 Fracture Maxilla - Repair & Plating
56 Fracture Nasal bones Reduction
57 Hypopharyngoscopy
58 Laryngeal Web Excision
59 Laryngofissure
60 Lateral Pharyngotomy
61 Lateral Rhinotomy
62 Ligation of Ext. Carotid Artery / Ant. Ethmoidal Artery
63 Lymph Node Biopsy
64 Marsupulization of Ranula
65 Mastoidectomy - Cortical
66 Mastoidectomy - Modified Radical
67 Mastoidectomy-Radical
68 Mastoidectomy Cavity Obliteration
69 MLS - Laryngeal Papillomatosis
70 MLS Diagnostic / excision of Nodule / Polyp
71 MLS with Decortication
72 Myringoplasty
73 Myringotomy with Grommet - Bilateral
74 Myringotomy with Grommet - Unilateral
75 Nasal Endoscopy
76 Nasal Packing - Anterior
77 Nasal Packing - Posterior
78 Ossiculoplasty
79 Pan Endoscopy (Nasal Endoscopy, Oesophagoscopy, Bronchoscopy)
80 Partial Glossectomy
81 Peritonsillar abscess (Incision & Drainage)
82 Pharyngeal Diverticula Repair
83 Pharyngeal fistula repair simple without flap
84 Pre Auricular Sinus Excision
85 Ptergopalatine Fossa Surgery
86 Repair of Oroantral Fistula with Flap
87 Sebaceous Cyst Neck Excision
88 Septo – Rhinoplasty
89 Septoplasty
90 Septoplasty + SMD
91 Stapedectomy
92 Styloidectomy - Bilateral
93 Styloidectomy - Unilateral
94 Sub mucous Diathermy
95 Submandibular Gland Excision
96 Superficial parathyroidectomy
97 Superficial Parotidectomy
98 Syringing of ears / Suctioning/ Wax Removal
99 Thyroidectomy - Partial/Hemi
100 Thyroidectomy - Subtotal
101 Tongue Tie
102 Tonsillectomy
103 Tonsillectomy - Laser
104 Total Laryngectomy with Block Dissection
105 Total Laryngopharyngectomy
106 Total Maxillectomy
107 Total Maxillectomy with Orbital Exentration
108 Tracheal Stenosis Laser
109 Tracheal Stenosis Laser + Ballooning
110 Tracheal Stenosis Laser + Ballooning + Stenting
111 Tracheal Stenosis Montgomery T- Tube
112 Tracheal Tumours - Endoscopic Excision
113 Tracheostomy
114 Trans – Antral Ethmoidectomy - Unilateral
115 Turbinate reduction
116 Tympanoplasty
117 Uvulo- Palato Pharyngoplasty
118 Vocal cord palsy - Cord lateralisation
119 Vocal cord palsy - Laser Arytenoidectomy
120 Vocal cord palsy - Teflon paste injection
121 Vocal cord palsy - Thyroplasty
122 Voice Prosthesis Insertion / TEP
123 Intratympanic Drug Delivery
124 Parapharyngeal Space Tumours Excision

Benign Paroxysmal Positional Vertigo BPPV

BPPV is a

BENIGN - not threatening to life
PAROXYSMAL- which comes suddenly without alerting you
POSITIONAL- comes with a head in a particular position
VERTIGO- a rotatory sensation of the head or of the surrounding.

BPPV is a very much treatable condition. The rotatory sensation originates in the head because there are some particles which has dislodged out of balance portion of inner ear and moved to some other place.

You can understand this way that ear is the chief balance organ of the body. other are eyes and joints. the information from eyes, ears and joint is conveyed to brain. Any mismatch in the information received by brain is perceived as imbalance of body. If ear is the mismatch organ, then this imbalance is typically rotatory.

So, BPPV can originates from trauma to head and this trauma may  be trivial. other causes may be because degeneration because of aging.

It requires a simple test (DIX HALL PIKE TEST) as I am doing in the photograph to know this condition and then by a simple procedure EPLEY MANEUVER, this form of vertigo can be cured.

If a patient come early, younger patient, involvement of one ear only carries a good prognosis.

Rest is important part after the maneuver so that particles can settled in their original position.

For instructions after Epley Maneuver CLICK HERE

Please post your query in the comments. I shall be happy to reply you.

Dr. Ajay Jain

Your Questions

Dear Sir,

Greetings!

I am suffering with Cholesteatoma in the middle ear bone of both ears and due to it I have lost my hearing power. I have been using hearing aid. I have had surgery for removal of the same but I can not recover my hearing power. Now, my recent CT Scan is reporting that it is growing again.

I request you to kindly give us your valuable advise. I will also provide you my CT Scan images on your e-mail.

Thanking you in anticipation.

With regards.

Arpana Sharma

Bhopal

Yours Questions

Dear sir,

I am 18 years old Student.  I am suffering from these listed problems from around last 5 or 6 years.

1. One or sometimes both of the nasals are blocked. It generally blocks when i am sitting still or lying on bed.
2. Runny and itchy nose along with blocked nasals. The discharge is mostly transparent and thin like water, but sometimes it becomes thick.
3. Pain in back side of head, specially when moving my head left-right or when bending my body.
4. Fatigue and tiredness.
5. Always Watery eyes.
6. Difficulty in sleeping during night because of congestion in nose.
7. I am feeling cough in my throat during speaking But Unable to spit it.
8. Feels like cough is passing from nose to throat inside. If i am not wrong this is called post nasal discharge.
9. Not always but sometimes, when i comes in contact with smoke or Dust(pollution on roads), Difficulty in breathing occurs.

• When i takes treatment from Physicians they treat it as common cold and gives medicines for 3,4 days. I get relief from these problems only till medicines are taken.

Please tell me what is the main problem, and what is its treatment. I am a CA student and because of these problems I am unable to concentrate in my studies and other works too.
Please respond me soon. I Want to get rid of these problems.


Sincerely,

Ashish Soni

Care of discharging ears

The care of a discharging ear is extremely important. Few principles are

1. Dry Mopping: Let the discharge come out of ear. for that the inside of pinna should be kept dry by mopping up with a dry cotton without using a stick or earbud. just mop with cotton and throw the cotton.
2. Prevent water from entering into ear especially while taking bath. for that use good quality silicone ear plugs or use a cotton ball smeared with vaseline or some medicated ointment like neosporin and then after bath, through the cotton immediately.
3. Never ever indulge in using earbud or matchstick to clean the ear.
4. Put some antibiotic steroids ear drops by keeping the discharging ear up for 10 minutes. Do not use cotton plug to stop drop coming out. These cotton balls may itself contain infection or leave some cotton fibers to cause infections. Do not worry if drop comes out of ear after 10 minutes.
5. If your ear is not responding, then a culture may be required especially for a fresh infection. do not resort to self medications.
6. Most of the ear problems are initially due to associated nasal problems so this is important to take care of nasal problems also otherwise ear will keep discharging.
7. Since Ear is made up of bony septa like a honeycomb, so an ear discharge may take 4-6 weeks to get dry. It's more fruitful to wait then to operate a wet ear. So be patient with the doctor. Few ears do not respond even to this, then they require to be operated in wet state only.

Please leave your query in the comment column or any other suggestion you would like to give.

Regards,

Dr. Ajay Jain

ENT Care

SOME USEFUL TIPS

1.Do not put oil, matchstick, hairpin or Ear buds into ears. They are harmful and can injure your eardrum.

2.Do not put just any ear or nose drops without medical consultation. They can be harmful.

3.Some ENT Diseases like ear discharge and Sinusitis takes time to cure. So have a good follow up with the Doctor and don’t discontinue the medicine on your own.

4. Maintain a file of your medical records date wise and always bring your previous consultation paper

Visiting Card

Dizziness and Vertigo

Dizziness and Vertigo

There are a multitude of causes of dizziness which may have nothing to do with the balance organ in the inner ear. Fainting attacks, heart problems, thyroid problems and brain problems can all give rise to feelings of light-headedness, giddiness and general imbalance.

One form of dizziness is vertigo which is the specific complaint of either the environment moving in relation to the patient or the patient moving in relation to the environment. It is usually a spinning or rotatory sensation. Vertigo is specifically linked to problems with the inner ear. Of the people who suffer from vertigo due to inner ear problems, 99% will recover with time and without any treatment.

Normal Balance

Balance and the ability to remain upright is dependent upon three systems:

All three of these systems give information to the brain about the position of the body in space. Generally people can keep their balance if two of the three systems are working, but they cannot cope with only one system working. This is why most people tend to become more unsteady as they get older, because they may have arthritis in their legs and their neck or poor eyesight.

The balance organ (or labyrinth) is made up of three semicircular canals and the vestibule, which are all filled with liquid. The semicircular canals sense rotational movement and the vestibule senses acceleration and deceleration.

Inner ear disease and vertigo

Many different factors can affect the inner ear and cause vertigo. One way to distinguish them is by the duration of the dizziness.

Short-lived episodes of dizziness (few seconds to minutes)

An extremely common type of vertigo is benign positional vertigo. This is typically a very sudden onset of dizziness, which settles rapidly after a few seconds or at most a couple of minutes.
It is often started off by the person suddenly looking upwards or sideways, and some people get it when they turn over in bed. In between attacks, the sufferer feels entirely normal. It is probably caused by a little piece of lining coming loose in the inner ear and floating into the balance receptor, causing a sudden increase in nerve stimulus to the brain.
Sometimes the attacks start following a whiplash injury or other head injury, but often there appears to be no reason that they should have started. The attacks usually disappear with time.
Medicines do not help, but a manoeuvre known as Epley's Manoeuvre can be extremely effective in some patients. This can be carried out either by the ear nose and throat surgeon or physiotherapy department, depending on the hospital.

Medium length episodes of dizziness (half-hour to several hours)

These types of vertigo are rarer and are thought to be due to an increase in pressure of the fluid in the inner ear, although nobody really knows for sure.
Menière's disease or endolymphatic hydrops result in episodes of severe vertigo that can last up to several hours. The dizzy episodes are usually linked with vomiting, and the sufferer can often tell an episode is about to start because he or she notices a drop in their hearing, a feeling of fullness in the ear and some tinnitus. The hearing recovers once the vertigo has settled, but may gradually deteriorate with time.
Treatment of Menière's disease can involve medicines and, more rarely, surgery, but this will be organised by your local ear nose and throat department once the diagnosis of Menière's disease has been made.

Longer episodes of dizziness: (days to weeks)

An infection of the inner ear (labyrinthitis) or an inflammation of the balance nerve (vestibular neuronitis) can give rise to severe rotatory dizziness for up to two to three weeks, with a slow return to normal balance which can take a further few weeks.
Again, the initial episode is often associated with vomiting and the patient can be bed-bound because the dizziness is so severe. This is best treated at first with a vestibular sedative such as Stemetil, but any treatment should be stopped quite quickly to allow the brain to compensate and recover from the dizziness. Recovery is much quicker in the long run if treatment with anti-dizziness medicines is not prolonged.
Investigations
The majority of patients who experience episodes of vertigo will recover without any long-term ill effects and usually within a few weeks or month of the onset of the symptoms.
In the majority, specialist investigations do not help with the diagnosis but they can be helpful in certain circumstances. If they are thought necessary, investigations of vertigo will generally be carried out in a hospital by a neurologist, general physician or ear nose and throat surgeon or a audiological physician. Types of test that may be requested include: audiological (hearing) tests, tests of balance, blood tests (rarely), and radiological examinations such as an MRI scan or CT scan.

Treatment

In general the treatment of vertigo is symptomatic, ie treatment is given to control the symptoms without regard to the specific cause of the vertigo. The body is very good at overcoming the imbalance experienced during inner ear disease, and so symptomatic treatment should be short because it can delay this natural compensation.

Rehabilitation (including Cawthorne Cooksey Exercises)

There are specifically targeted exercises to speed up the brain’s natural compensation after inner ear disease. Recovery can be hastened by these exercises which can be organised by your local ear nose and throat or physiotherapy department.

Vestibular sedatives

The inner ear may be ‘suppressed’ (or made sleepy) by the use of drugs such as Stemetil or Stugeron. These drugs reduce the overactivity of the balance organ and so reduce the dizziness and vomiting that can occur in inner ear problems.
However, they are not a long-term solution and should be used for as short a time as possible because they prolong the time taken for the body to readjust after the vertigo.

Menière's disease

This is a longer term disease and there are two aims of treatment. One is to treat the acute episodes of dizziness with vestibular sedatives (see above), and the other is to try to reduce the frequency of the dizzy episodes.
Frequently advice will be given to restrict intake of salt, caffeine and alcohol, which can help some patients with Menière's disease. Increasing the bloodflow of the inner ear may help and so drugs like Betahistine (Serc) are often prescribed.
Some people with Menière's disease may benefit from surgery if the episodes of vertigo are frequent and disabling and not responding to medical treatment.

When surgery is needed

Surgery may be advised if medical treatment proves ineffective and the episodes of vertigo are disabling. The options range from those such as the simple insertion of a grommet through to operations which completely destroy the inner ear, or divide the nerves leading from the inner ear to the brain.
Unfortunately, many (although not all) effective surgical operations also destroy the hearing of that ear and so the vertigo is usually severe before a patient opts to undergo such treatment.
Because there are so many different causes of vertigo, there are several different operations and so it would take too much space to detail them all here, but your ear nose and throat consultant will go through them with you.

New treatments

There are always new treatments being developed and there is very encouraging progress being made using drugs delivered directly into the ear which selectively destroy the inner ear balance mechanisms without affecting hearing.
Further work is still to be undertaken in this area and will no doubt result in improved techniques for the control of vertigo in patients who are long-term sufferers. Anyone suffering from persistent recurrence of vertigo should consult their doctor in order to find the cause and to arrange effective treatment.