Dr. B. B. Khatri

You should consider undertaking a cochlear implant in case you are experiencing hearing loss or are turning deaf. This is a small device that gets planted in your ear through a surgical procedure. It sends impulses to your auditory nerves directly, as a result of which sound signals get carried to your brain. Cochlear implants may not make you hear normally again, but help you with different sounds, and in the recognition of the different sounds around you like alarms, telephones, and door bells.

How it works?

1. A cochlear implant is fit for children and adults who suffer from the sensorineural hearing loss. This condition damages the tiny hair cells in your inner ear, which is called the cochlea. Hearing becomes impaired when these get damaged.
2. The device consists of two specific parts. The first part or the receiver-stimulator is placed under your skin via a surgical procedure. The other part of the device is the speech processor. It has to be worn around your neck in the form of a hearing aid.
3. The external device is, however, larger in size than a usual hearing aid. The receiver gets placed under your skin, behind the ear via a small incision. It is connected to electrodes.
4. This is inserted into the cochlea of your inner ear. The surgery requires a few hours to be undertaken successfully.
5. The speech processor has to be placed two weeks after the surgery is undertaken. The processor can be connected to the microphone, and this can be worn around the ear.
6. You can wear it on any other part of your body, based on your lifestyle and age.

Benefits of cochlear implant
The major benefits of a cochlear implant are as follows:

1. You might be able to hear speech almost normally.
2. You will be able to understand speech better, and will not have to depend on lip reading.
3. It will be much easier and simpler for you to listen to the television and talk over the phone.
4. You will be able to listen to music better.
5. You may also be able to pick up various sounds around you that include soft, medium, and loud sounds.
6. You will be able to control your own voice better. This makes other people understand you better.

If you are suffering from severe hearing loss, a cochlear implant may be able to change your life for the better. However, the results are not the same for all, and vary among people. It is possible for some people to benefit more from such an implant than others.

Cochlear implant is a medical device that provides direct electrical stimulation to the hearing nerve in the inner ear. Children and adults with a severe hearing lossmay be helped with cochlear implants. A cochlear implant is a prosthetic substitute directly stimulating the cochlea and it does not cure deafness or hearing impairment.

A cochlear implant completely by-passes the normal hearing mechanism and stimulates the auditory nerve directly by means of an internally implanted electrode assembly. The implant consists of an external portion that located behind the ear and an interior portion which is surgically implanted under the skin. An implant has a microphone, a speech processor, a transmitter and an electrode array. The sound from the environment is picked by microphone and transmitter and receiver/stimulator sends them to speech processor to convert them into electric impulses.

The speech processor placed with the microphone behind the ear, or it is a small box-like unit worn in a chest pocket. The speech processor digitizes the sound signals and sends them to a transmitter just behind the ear. The electrode array collects the impulses from the stimulator and sends those to different regions of the auditory nerve. The electrodes stimulate the fibers of the auditory nerve, and sound sensations are perceived.

A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so that they can be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Hearing via a cochlear implant is different from normal hearing and takes time to adjust. However, it enables many people to understand other sounds in the environment, recognize warning signals, , and understand speech in person or over the telephone.

The benefits from a cochlear implant depend on many factors, such as the age of the patient when he or she receives the implant, the hearing loss present pre or post patient developed language skills and finally the motivation of the patient and family support.

Once a person is referred for cochlear implant, more testing is done which includes audio logic testing, psychological testing, medical examination, and tests performed by the surgeon. It is done to ensure that the candidate will benefit from a cochlear implant and will have the motivation to participate in the process. Once the decision is made to go ahead, the surgery is done. Sometimes it involves an overnight stay in the clinic, and sometimes it is done on an outpatient basis. Six weeks post-surgery, patient is fitted with the external microphone and speech processor and implant is activated and programmed.

The best candidates are those having severe hearing loss in both ears, limited benefit from hearing aids, medical condition that makes surgery risky. Children can be considered for cochlear implants if they have the similar conditions as adults and in addition have support from their educational institutions to development of auditory skills.

Sleep apnea is a potentially dangerous sleep disorder in which you stop and start breathing frequently while you are sleeping. Symptoms of sleep apnea often include loud snoring and fatigue even if you sleep uninterrupted through the night. Obesity and age are the common risk factors of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea, in which the throat muscles contract and relax while you are asleep. The other type of sleep apnea, called central sleep apnea, usually occurs in people who have been diagnosed with brain tumors, infections or heart failure, or have had a stroke.

Treatment of sleep apnea includes:

1. CPAP: The Continuous Positive Airway Pressure (CPAP) device is generally recommended in the treatment of sleep apnea. CPAP is a breathing machine that stops your airways from getting blocked when you are sleeping. The CPAP device is normally the size of a tissue box. It comes with a mask that you put over your mouth and nose. The machine attached to the mask pumps a continuous flow of air that keeps your airways clear as you sleep.
2. BPAP: The Bilevel Positive Airway Pressure (BPAP) device is used as an alternative to the CPAP device, if you find it hard to adjust to the CPAP. If you have a weak pattern of breathing, the BPAP can be helpful.
3. ASV: The Adaptive Servo-ventilation (ASV) device is used to treat both central and obstructive sleep apnea.
4. Treatment for other medical conditions: Sometimes sleep apnea can be caused by underlying health conditions. Problems such as rhinitis (nasal passage inflammation) and hypothyroidism (underactive thyroid gland) can cause sleep apnea. In such cases, your doctor needs to diagnose these conditions first before treating your sleep apnea.
5. Lifestyle changes: Excessive weight sometimes can cause sleep apnea; so losing excessive weight should be a priority. Also, alcohol and tobacco can contribute to your symptoms, so try avoiding those.
6. Medication: Usually, doctors do not prescribe any medicine, since sedatives and sleeping pills actually worsen sleep apnea. But, in case of sleep apnea in children, doctors typically suggest intra nasal corticosteroid medicine to treat the symptoms.
7. Surgery: Surgeries to increase the size of your airway or to remove your adenoids, tonsils or extra tissues in the rear of your throat or your nose can prove helpful.

Did you know your earphones are making you deaf? Here's how.

Fact: Roughly 1.1 billion people worldwide within the age group of 12-35 have been found to be at an increased risk of developing hearing problems.

Listening to loud music on handheld devices using earphones has become a common trend among youngsters these days. You might find it very relaxing to plug in your earphones and escape into your own world of music, but you need to know that this can cause serious damage to your ears. The worst part: you won't realise your ears are being damaged until it's too late.

So, exactly how is loud music damaging your ears?

Continuous exposure to loud music from earphones or other sources results in a medical condition known as Noise-Induced Hearing Loss (NIHL), which can be associated with irreversible damage to the ears resulting in deafness.

When you hear loud music for a considerable amount of time every day it affects your hair cells (nerve cells responsible for sending sound signals to the brain) negatively, so that their ability to respond to sound decreases. If this keeps on happening for many months, eventually the hair cells are damaged beyond repair. These cells cannot be regenerated, making you permanently deaf.

How loud is too loud?

If your ears are exposed to sounds at 95, 100, 105, 110 and 115 dB (decibel, the unit used for measuring sound) for 4 hours, 2 hours, 1 hour, 30 minutes and 15 minutes each day respectively, your ears are at risk of getting severely damaged. Also, playing music at 120 dB or above can damage your ears instantly. You can have a realistic idea about the relation between decibels and sounds you commonly hear by referring to this list:

1. 30 dB: soft whisper
2. 75 dB: busy traffic
3. 90 dB: noise of a motorcycle at 25 feet
4. 100 dB: noise of a farm tractor
5. 140 dB: jet plane taking off

Moreover, if you experience the following symptoms regularly, there's a high chance that you need to get your ears treated soon:

1. A ringing sound in your ears when you are at a quiet place, which vanishes after a few minutes
2. You need to raise the volume of TV or music to the fullest to hear it properly
3. You have difficulty in hearing people talking at a distance of just 3 feet

Tips For Safer Listening

1. Use earplugs: The louder the noise and the longer you're exposed to it, the greater the chance of damaging your hearing. Protect your ears with ear protectors – earplugs or earmuffs – and get away from the noise as quickly or as often as you can. 
2. Turn down the music: Don't listen to your personal music player at very high volumes and never to drown out background noise. If the music is uncomfortable for you to listen to, or you can’t hear external sounds when you’ve got your headphones on, then it's too loud. It's also too loud if the person next to you can hear the music from your headphones.
3. Use the 60:60 rule: To enjoy music from your MP3 player safely, listen to your music at 60% of the maximum volume for no more than 60 minutes a day. 
4. Wear headphones: When listening to your personal music player, choose noise-cancelling headphones, or go retro with older muff-type headphones. Ear-bud style headphones and in-the-ear headphones are less effective at drowning out background noise. 
5. Turn down the dial: Turn down the volume on your TV, radio or hi-fi a notch. Even a small reduction in volume can make a big difference to the risk of damage to your hearing. 
6. Use earplugs when you’re listening to live music: They can reduce average sound levels by between 15 and 35 decibels. They’re widely available at many live music venues and shouldn’t spoil your enjoyment of the music.
7. Don't put up with work noise: If you’re experiencing noise at work, talk to your human resources (HR) department or your manager and ask for advice on reducing the noise and getting hearing protection.
8. Wear ear protectors: Wear ear protectors (earplugs or earmuffs) if you are using noisy equipment such as power drills, saws, sanders or lawn mowers.
9. Be careful in the car: Listening to music in a confined space increases the risk of hearing damage. Don’t listen to music too loud for too long.
10. Have a hearing detox: Give your ears time to recover after they’ve been exposed to loud noise. According to Action on Hearing Loss, you need at least 16 hours of rest for your ears to recover after spending around two hours in 100dB sound, for example in a club. Reducing this recovery time increases the risk of permanent deafness.

 In case you have a concern or query you can always consult an expert & get answers to your questions!

The ear is made up of three parts that is outer, middle and the inner part. Infections, disorders and ailments in the ear can occur across all age groups and in any part of the ear. Ear ailments are more common in children than in adults as the Eustachian tubes (tubes which drain out ear fluid) are smaller in children.

Here are a few common ailments which occur in children:

1. Acute otitis media: AOM is the most common ear infection in children. Some parts of the middle ear are infected, resulting in swelling and blockage of fluid behind the eardrum. This condition is characterised by earache in children and in graver conditions, can also cause fever.
2. Otitis media with effusion: This condition usually occurs due to the infestation of an infection when the fluid gets restricted behind the ear drum. This condition doesn’t exhibit too many symptoms except mild earache. You should visit an ENT specialist who can diagnose this condition by checking the concentration of fluid behind the eardrum using special instruments.
3. Chronic otitis media with effusion: This condition occurs in children when the fluid remains trapped behind the eardrum for a long period of time. It can lead to serious infection and cause problems in hearing in children.
4. Barotrauma: Barotrauma occurs due to changes in atmospheric pressure changes. It can cause problems in the Eustachian tube and causes trapping of air in the middle ear. Middle ear problems can become severe if left untreated and result in a burst in the eardrum, causing excessive bleeding.
5. Meniere's disease: This is a disorder, which comes in bouts and is characterised by vertigo and fluctuating hearing loss. This condition usually affects one ear. It can result in tinnitus (ringing in the ear) or permanent loss of hearing if left untreated.
6. Swimmer’s ear: Swimmer’s ear, also known as otitis externa, is a common condition which is caused in the outer area of the ear. This condition is caused due to remnants of chlorine water in the ear or because of inserting swabs too deep inside the canal. This condition is characterised by earache, discomfort and itching of the ear.

Benign paroxysmal positional vertigo is among the common causes of vertigo. It is the sudden sensation of the spinning of your head which occurs with the change of position of your head. It is a disorder of the inner ear. It occurs when calcium carbonate crystals accumulate in large numbers in any one of the ear canals and stimulate abnormal fluid movement in the inner ear. This sends false signals of head movement to the brain. This can also crop up post head injury. Rolling over the bed or quick head movements like when sitting up in bed can also trigger this condition. 

The common symptoms of benign paroxysmal positional vertigo are as follows:

1. Vomiting and nausea. 
2. Vertigo Blurred vision
3. Intense dizziness 
4. Loss of balance 

Benign paroxysmal positional vertigo may be treated in the following manner:

1. Medication to get relief from the spinning of your head. 
2. Epley's Maneuver involves transportation of the calcium particles to a different part of the ear which will no longer cause any problems. 
3. Brandt-Daroff exercises. 
4. Sometimes watchful waiting can help a person to recover without having to undergo any other treatment but it is a long process and often involves risk factors. 
5. Surgery: This option is used rarely when other treatments fail. 

A very important thing to remember is that vertigo can lead to falls and driving should be avoided. The patient will need support during an episode to avoid injuries.

Otitis media or an ear infection which affects the middle ear, due to a viral or a bacterial attack. It is a painful condition that crops up due to fluid build-up in the middle ear. Since infections of this nature clear on their own, the treatment concentrates on pain management, and locating the underlying problem that caused the infection. Mostly, children under the age of 10 get affected by this condition. Persistent infections can lead to serious complications such as otitis media with effusion, chronic suppurative otitis media and chronic otitis media with effusion.

Causes of Otitis Media
Otitis media is the result of an infection caused due to a bacteria or virus attack. This condition is often triggered by underlying illness such as allergy, cold or flu. It causes swelling and congestion of the nasal passage eustachian tube and throat.

Role of Eustachian tube
The eustachian tubes are a couple of narrow tubes that run from the middle ear to the throat, behind the nasal passage. The throat end of the tube opens and closes, to perform functions such as regulate air pressure, refresh the air in the ear and drain the normal secretion from the ear. Mucus, swelling and inflammation in the eustachian tubes results in accumulation of fluid.

1. Children aged between 6 months to 2 years are more vulnerable to otitis media, because of the smaller size and shape of the eustachian tube.
2. Babies, who drink from a bottle while lying down, tend to suffer from eustachian tube infection, compared to babies fed from a plate in an upright position.
3. Ear infections are prevalent during the winter and fall season. People who suffer from seasonal allergies have a greater probability to suffer from otitis media.
4. People who are exposed to a high level of air pollution and tobacco smoke, have a greater chance to suffer from air infection than their counterparts.
5. Professional swimmers who spend a long time in pool tend to suffer from ear infection compared to others.
6. Children who are kept in a group child care setting, tend to suffer from ear infection. This is owing to a high exposure to cold and infection from other children.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Good morning, I am doctor Khatri I will tell about hearing loss.

So the hearing loss is a very common problem which occurs with the ageing process and it can occur because of persistent and prolonged noise exposure. It's a difficult problem which happens throughout the world and it can be of two types - conductive and sensorineural hearing loss. Hearing is very important for the life because if there is a hearing loss then we don't enjoy discussions, talking and especially music and other environmental sounds.

So there are two types of losses conductive hearing loss - the conductive hearing loss is because of diseases in the external and middle ear because of repairment in the conduction of the sounds. External ear and middle ear which contains small bones which are as far as more conductive of the sound to the inner ear.

Common causes for sensorineural hearing loss is post viral process which is involved in the inner ear the reason being due to prolonged exposure to the noise for long duration and there is a congenital in an inner ear that auto slow system which involves the nerves inner ear. Then there can be minute diseases to most of the inner ear are driven, the inner ear bones it can be because of trauma and injury which involves a texture of the ear bones and then it can be because of understanding worm formation.

The treatment for the hearing loss is depending on the cause we treat - the cause like infection is there then we give antibiotic and ear drops, wax can be removed then malformation in the ear trunk that can be replaced by an operation. Then in the other diseases like minute diseases are also treated with medical on the auto slow system which is treated by the century and that could be use of hearing track, it also moderates to severe hearing loss.

The hearing, that is used to specify the sound and especially is able to hear. Then there can be surgical treatments involving whatever the cause of the diseases is here, so the prevention is more important than cure . So always we have to take preventive steps like exposure to the loud noise should not go longer duration, ear phones which are normally nowadays teenage children are using , which should not be used for higher volume with long time duration . Any medicine can cause hearing loss and that should be avoided .

If there is a hearing loss and then there are certain operations if there is a profound or a lot hearing loss, total hearing loss and there is a surgery called Choclear Implant surgery, that can be done. Thank you.

Allergic rhinitis is characterized by symptoms of a runny nose, congestion, itchy eyes and sneezing. This disorder is usually caused by allergens such as pollen and dust. Commonly known as hay fever, allergic rhinitis may exhibit the following symptoms:

The symptoms of allergic rhinitis are:
1. You may experience a runny nose and congestion in the nose
2. You may have allergic conjunctivitis where your eyes turn itchy and watery
3. Persistent coughing
4. Symptoms of sneezing
5. Swelling may develop underneath the eyes
6. You may have an itchy nose
7. Constant signs of fatigue

Causes
Allergic rhinitis or hay fever causes the immune system to recognize certain airborne substances as harmful. The immune system in the body starts to form antibodies to combat these irritants. The antibodies cause the body to release “histamine”, a chemical that triggers the symptoms of allergic rhinitis.

The various triggers that may cause allergic rhinitis are:
1. Dust mites
2. Tree pollen
3. Grass pollen
4. Spoors from outdoor and indoor fungi
5. Ragweed pollen

The treatment for this disorder is to avoid exposure to the triggers. Mild symptoms of this disorder may be treated with over-the-counter medications whereas severe symptoms may require prescription medications.
The various medications for allergic rhinitis are:

1. Antihistamines: Antihistamines may be administered as pills or nasal sprays; these medications can help with itching and sneezing. Antihistamines help in limiting the effects of histamine in the body.
2. Nasal corticosteroids: These prescription medications can help treat itching and inflammation in the nose. They are usually the first medications that are administered.
3. Decongestants: Decongestants are over-the-counter medications that can be used to treat congestion in the nose. You should be careful not to overuse these medicines as they can increase blood pressure.
4. Allergy shots: If medications do not relieve symptoms of allergic rhinitis, the doctor may prescribe allergy shots to treat the disorder. The injections contain allergens in small amounts which are injected over a period of time; this causes the body to get used to these allergens, resulting in a reduction of the symptoms.

In case you have a concern or query you can always consult an expert & get answers to your questions!

What is a foreign body (FB)?
Foreign body or FB is an object or piece of extraneous matter that has entered the body by accident or design. It is common to see certain items getting stuck in the ear, nose or throat especially, in young children. While most of the time they do not raise an alarm, however, sometimes they can lead to severe consequences like rupture of the eardrum or even choking.

How do FBs affect ear, nose and throat?

• Children over 9 months develop an ability to pick up objects. As they explore the environment around them, they tend to put items such as peas, beans, marbles, beads, cotton, paper, etc, in their mouth, nose or ears. A similar trend can be seen in adults with mental disorders.
• Trauma/ fall/accident can force FBs like rock, pebbles into the ear, nose or throat.
• Adults while riding a bike or sleeping on the ground (campsites) can have insects: flies, ants, roaches fly into the nose or ear.
• Choking occurs when FBs block the airway, common reasons are: not chewing the food properly, diseases like Parkinsonism, drinking alcohol or certain drugs that slowdowns the process of swallowing.

Managing FB in the ear, nose and throat

Foreign bodies in the ear
Symptoms: Pain in the ear, discharge or bleeding from the ear, feeling of fullness or pressure in the ear and dizziness and nausea in extreme cases.

Management:

• Make sure the patient is sitting in an upright position, pull the pinna or outer semicircle of the ear towards the back. This can help you see the object clearly and also loosen it to wiggle out. If you can see the object clearly, use a tweezer to grasp the object and gently remove.
• In case a live insect gets trapped inside the ear lie down and place few drops of warm vegetable or baby oil. Use oil only if symptoms of eardrum perforation like pain, bleeding/discharge from the ear is absent.
• Tilting the head to the affected side can facilitate gravity to dislodge the object.

Foreign bodies in the nose:
Symptoms: Pain and difficulty in breathing from that side of the nose.
Management: Keep the uninvolved nostril closed by pressing a finger against the side of the nose and gently ask the person to blow from the affected nostril.

Foreign bodies in the throat:
Symptoms: Choking, inability to breathe and speak 
Management: Perform Heimlich maneuver: abdominal thrusts, if trained otherwise, it is advised to call for medical help immediately.

How can you prevent foreign bodies from entering your ear, nose, throat?

• Discourage talking, playing, laughing when food is in the mouth.
• Do not give whole grapes, popcorn, nuts to children below 3 years.
• Keep small objects out of reach of small children.
• Teach children to avoid placing objects into their nose, ears.

In case you have a concern or query you can always consult an expert & get answers to your questions!