Dr. Harmeet Singh Pasricha

Sleep Apnea refers to sleep disorder which is characterized by irregular pauses or interruption in breathing during sleep. Every pause usually lasts for a few minutes or seconds and occurs several times at night. This may indicate that your brain as well as rest of your body is not getting sufficient supply of oxygen. Sleep apnea is of two types - Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA).

1. Obstructive Sleep Apnea- This occurs when the air passage gets blocked, generally when the throat muscles periodically relax and obstruct your air passage during sleep. It is the most common type of sleep apnea and is characterized by snoring.
2. Central Sleep Apnea- In this case, the airway does not get blocked, but the brain stops passing signals to the muscles that control your breathing.

Mostly people who are diagnosed with a number of underlying medical conditions such as obesity, diabetes, hypertension, chronic nasal congestion etc. are prone to Obstructive Sleep Apnea. Although Central Sleep Apnea is a less common type of sleep disorder, and does not lead to serious complications, various research studies show that Obstructive Sleep Apnea can pose adverse consequences if not treated at the right time.

One such fatal consequence is cardiovascular problems. Sudden drops in the levels of oxygen in blood that happens during Obstructive Sleep Apnea results can lead to increased blood pressure and damage of the cardiovascular system, which in turn increases the chance of a heart attack. Since men are more prone to heart ailments than women, men with sleep apnea are at a greater risk of heart ailments like stroke or heart failure, coronary artery disease and others.

Since Obstructive Sleep Apnea occurs due to interruption in the breathing procedure, it can lead to abnormal irregular heartbeats, known as arrhythmia. Arrhythmia can decrease the level of oxygen in blood and if there’s an underlying heart condition, these repetitive encounters of low blood oxygen can even lead to a sudden cardiac arrest.

Most research studies have established a positive correlation between sleep apnea and heart ailment. According to researchers, the risk of untimely death increases as the acuteness of sleep apnea increases. However, there are ways of seeking treatment for this particular sleep disorder. You should consult a doctor immediately and get yourself proper medical assistance to prevent the condition from aggravating.

Strep throat is a common bacterial infection mostly seen among young adults and children, caused by Streptococcus pyogenes, a group A bacteria, that leads to pain and inflammation in the throat. While some people may have mild symptoms, others may encounter more serious symptoms such as high fever and chills, sore throat, swollen glands, loss of appetite, and difficulty in swallowing food.

If you don’t treat the condition soon enough, strep throat can be really painful and troublesome. Although the ideal treatment option for this condition is antibiotic medications, research studies show that they are only effective in reducing the span of the infection by about half a day. Moreover, antibiotics have adverse side effects on your health, so it is always advisable to steer away from those heavy doses. The best way to keep yourself healthy and free from a strep throat is to prevent it from the very beginning. Here are a few steps you can follow to prevent yourself from getting a strep throat-

1. Avoid contact- Coughing and sneezing which are the usual symptoms of a strep throat, can be contagious. The infection usually spreads from person to person so make sure you do not come in contact with the person suffering from a strep throat for at least a week or two. Also, keep your mouth covered if you ever come in contact with a sick person.
2. Maintain good hygiene- Good hygiene is the key to a healthy body. In order to keep the infection at bay make sure you use an anti-bacterial soap or hand wash to clean your hands before and after you have your meal. If you’re traveling around then always carry a hand sanitizer.
3. Change your diet- Include lots of fluid to your diet. Drinking lots of water and fluids will not only keep you hydrated, but will also moisten and lubricate your throat therefore reducing your chances of being affected by a strep throat. Include vitamin supplements or food that are rich in vitamins and avoid spicy or citrus food as they are likely to cause an irritable strep throat.
4. Avoid smoking- Smoking causes irritation to the throat tissues, which in turn increases the chance of getting a strep throat. So stop smoking, and avoid coming in contact with smokers as well.

Although strep throat may not sound like a chronic illness, it can lead to serious complications if not prevented at the outset. Since there are no proven vaccines to prevent the infection, adopting these aforementioned steps can help you stay away from a strep throat. In case you have a concern or query you can always consult an expert & get answers to your questions!

Ear infection is caused when viral or bacterial infection affects the middle ear which in turn leads to inflammation and accumulation of fluid behind your eardrums. Although anyone can encounter an ear infection, it is one of the most common conditions observed in infants. The initial symptoms may include fever, pain in the ear, release of pus from the ears, and a persistent throbbing in the ear. Ear infection can be very painful and troublesome if not treated soon enough. National Institute of Health reports that in most cases the infection disappears on its own without much trouble, but in rare occasions they may leave you with adverse complications that you must be aware of.

1. Hearing impairment- If you suffer from a chronic ear infection or if the infection has recurred after the treatment, you can face problems hearing. As we know, the infection occurs when fluid accumulates in your middle ear. If the fluid is not completely drained out, it may result in partial hearing loss. On the other hand, if the fluid remains trapped inside the ear for long it will harm the eardrums and the surrounding bones permanently, eventually leading to permanent hear loss. This condition poses far more a serious threat to infants as they are at risk of language and speech development delays as a result of hearing impairment.
2. Ruptured eardrum- Rupture in the eardrum refers to tear or hole in the tympanic membrane or eardrum. Tympanic membrane is the fine tissue which separates the exterior ear canal from the middle ear. When fluid gathers behind your eardrum, the resultant pressure can break open the eardrum. This can cause blood or pus to flow out from the ears. If the situation does not resolve on its own, you may have to go for a surgery.
3. Mastoiditis- This condition occurs when the mastoid bone that is situated right at the back of your ear, becomes infected due to infection in the middle ear. In order to perform its function properly, the mastoid needs to receive air from different sections of the ear along with the Eustachian tube which acts as the bridge between the rear side of your throat and the middle ear. If the infection in the middle ear obstructs the Eustachian tube, then it can result in the infection of the mastoid bone. In certain cases, Mastoiditis can lead to brain abscess or Meningitis, an infection in the tissues covering the spinal cord and the brain, caused by bacteria.

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

Traditionally, people resort to hearing aids in order to take care of their auditory problems. The perception of hearing reduces as age progresses and people find it absolutely necessary to come up with ways by which they can improve their hearing. However, cochlear implants have become extremely popular because of the method that it uses in comparison to the traditional methods of hearing aids.

What is a cochlear implant?

A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants bypass the damaged hair cells of the inner ear (cochlea) to send signals to Auditory nerve. Cochlear implant bypass the damaged hair cells in cochlea & send signals to Auditory nerve.

Who can they help?

The cochlear implant technology can help people who:

1. have moderate to profound hearing loss in both ears
2. receive little or no benefit from hearing aids
3. score 50% or less on sentence recognition tests done by hearing professionals in the ear to be implanted
4. score 60% or less on sentence recognition tests done by hearing professionals in the non-implanted ear or in both ears with hearing aids.

Many people have cochlear devices in both ears (bilateral). Listening with two ears can improve your ability to identify the direction of sound and separate the sounds you want to hear from those you don’t.

What are the benefits of a cochlear implant?

Many adults with cochlear implants report that they:

• Hear better with a cochlear implant than with a hearing aid
• A previous study has shown that people with a cochlear implant achieve an average of 80% sentence understanding, compared with 10% sentence understanding for hearing aids1.
• Can focus better when in noisy environments.
• Find it easier to have conversations with people across meeting tables, in restaurants and other crowded places.
• Reconnect with missed sounds that they could not hear before their cochlear implant.
• Feel safer in the world as they can hear alarms, people calling out and approaching vehicles.
• Talk and hear on the phone.
• Enjoy music.

??How is a cochlear implant different from a hearing aid?

A cochlear implant is very different from a hearing aid and is appropriate for individuals for whom hearing aids fail to provide benefit. A hearing aid makes sounds louder. Sound still travels through all the portions of the ear (outer ear, middle ear, inner ear) to the hearing nerve. A cochlear implant bypasses these structures and directly stimulates the hearing nerve with electrical energy. Because hearing aids amplify sounds and rely on the hearing system to convey the message, people with severe to profound hearing loss may be able to hear, but not understand speech well. The main objective of a cochlear implant is to improve speech understanding in quiet. Clarity with a cochlear implant is usually better than a hearing aid because the implant does not make sounds louder but delivers them to the hearing nerve.

There are a number of symptoms, which people should be looking out for before concluding that they have a hearing disorder:

1. Inability to hear properly
2. Excessive ear pain and stress on the brain
3. Failure to communicate properly
4. Discomfort in the mouth or nose
5. Other feelings of anxiety or stress that may actually be a consequence of the hearing loss problem

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

Hello, I am Dr Harmeet Singh Pasricha I am an ENT specialist working in Gurgaon for last 20 years. Today I am going to speak on a topic called paediatric obstructive sleep apnea or paediatric OSA. This is a common condition in children which present as mouth breathing during sleep during children and there is snoring also during sleep. This happens usually in the age group of 4 to 8 years during sleep it happens because there is an abstraction in the nose patient cannot breathe through the nose so it starts breathing through the mouth. This happens because of increase in the size of the tonsils and adenoids, tonsils are a pair of lymphatic tissue in the throat and adenoid is similar tissue which is situated in the midline behind the nose in the throat. When these adenoid increase in size then there is obstruction of the nose from the back side so a child cannot breathe through the nose. So in advertly opens the mouth to breathe, there is lack of oxygenation in the body and patient is restless during sleep and because of continued mouth breathing because of the growing age in the children, there are changes which developed in the face and nose of the patient. In it the front teeth come out and the pallet which is the partition between the nose and the throat it goes up, the development of the nose is reduced it forms the pins nose and the bones of the cheek they elongate downwards and the patient develops and adenoid faces. So because of the growing age, this has to control and we have to manage the patient medically. Initially, if the medical management of the patient fails then we have to go in for surgery. The surgery involves removal of the tonsil that is tonsillectomy and removal of adenoids that is adenoidectomy. Now because of its a procedure is done under general anaesthesia and adenoidectomy is now usually these days done under direct vision using the endoscopic technique transnasal or transoral technique and it is done with powered instruments now usually using micro debrider or coblation and adenoidectomy is done, so which opens up the space of the nasofarings and patient can breathe through the nose and tonsils are also removed. So the airways opened up and once the patient breathes smoother nose properly, he gets proper oxygenation and the shape of the face can be prevented from distortion. Thank you, you can contact me at my clinic a Dr Pasricha’s ENT & Eye Care Centre, Old Jail Land Complex, Sohna Adda, Gurugram, or at Columbia Asia Hospital, Palam Vihar, Gurgaon or you can book an appointment on lybrate.com. Thank you.

Nose polyps are swellings on the fleshy part, that tends to develop in the lining of the nose and paranasal sinuses, which are the spaces filled by air and linked to the nasal cavity. These growths are non-cancerous in nature. Polyps can be of different sizes and could be either pink or yellowish-brown in colour with the shape of teardrops. Polyp may arise and grow in one or both the nostrils at the same time. They can grow in clusters.

Polyps which grow on to become large or those occurring in clusters can result in breathing problems and can hamper a patient’s ability to smell. Sinuses could get blocked and certain problems might emerge, like regular infections.

These nose polyps cause problems to around 40% of the general population and these are more common in among males, affecting them at least 2 times more than they do to women.

Individuals, who suffer from asthma, sinus infections on a frequent basis and allergies are more prone to developing this problem.

Symptoms
People suffer from chronic inflammation in the lining of the nasal passages and sinus. There could be obstruction in the nasal passages and sinuses as a result of clusters. Some people having small polys in their nose may not have any signs or symptoms. If the symptoms do arise, then they include:

1. A patient might feel as if they always have cold, due to runny nose.
2. There could be problem in breathing as the nose tends to remained stuffed or blocked, causing difficulty while sleeping.
3. A feeling wherein mucus seemed to continuously run down the back of the throat.
4. Snoring is also one of the symptoms.
5. Itchy feeling around the eyes.
6. Person with nose polyp can have obstructive sleep apnea in severe situations. This can be potentially serious, where a patien’s breathing stops while at sleep.
7. There could be double vision, especially if a patient has cystic fibrosis.

Causes
The actual causes of nasal poly are not known but a number of these cases are linked to non-allergic asthma.

The exact mechanism of polyp formation remains unknown but medical researchers believe that they appear from swelling in the nose or sinuses.

Some are of the opinion that inflammation is caused due to accumulation of fluid in the space between the cells of the nose and sinuses that form mucus. Ultimately these heavy cells are pulled down by gravity, resulting in polyps.

Scientists feel that bacteria or viral infection, any allergy or immune response to fungus are the possible triggers.

Treatment
Some of the commonly used treatment methods for nasal polyps are:

1. Steroids – A doctor can prescribe nose drops or a steroid spray, which would help shrink the polyps by reducing the inflammation. This is common for those patients with few small polyps.
2. Steroid Tablets – In severe cases, patient might be given steroid tablets, which could be taken on their own or through nasal spray. They are very effective in shrinking the polyps.
3. Surgery – If the polyps are large in size, then surgery is the only option available or it could also be undertaken if the patient does not show improvements through other modes of treatment.

A nose surgery (rhinoplasty) is performed to alter the structure and shape of your nose and improve its function and or appearance. Here are a few things you should know about nose surgeries: 

Consult your doctor:

Before deciding on undergoing a nose surgery, talk with your doctor regarding issues with your nose. Your doctor will check your problems and judge whether or not surgery is a feasible option. It is only with your doctor's confirmation that you should go for the surgery.

Procedure:

1. The surgery is done either with local anesthesia (your nose and surrounding areas will be numbed) or general anesthesia (you will fall asleep).
2. The surgeon will make incisions in your nostrils and base of the nose and alter the shape, structure and position of the cartilages in your nose for appealing shape and better functionality. 

Recovery after the surgery:

You will be required to wear a nose splint. You can expect swelling around the eyes, which will begin to subside after the third day. Swelling in the nose will go away after six months. Therefore, do not expect to see your results immediately, final condition of your nose will be apparent after the recovery period is over.

You should avoid strenuous activity for 3 to 6 weeks. Do not smoke or drink alcohol during recovery. Smoking slows recovery time and alcohol reduces normal effects of drugs. Will you develop scars? As with all cosmetic procedures, rhinoplasty can leave scars.

Closed rhinoplasty: Incisions are made inside the nostrils and hence there is no scarring.

Open rhinoplasty: An additional cut is made along the columella and this may result in scarring. However, the position of the scar is such that it is almost unnoticeable.

Risks

Any surgical procedure has certain risks. These risks associated with nose surgery include:

1. Infection
2. Adverse effect to anesthesia
3. Unfavorable outcomes
4. Visible scarring
5. Numbness
6. Difficulty breathing
7. Chronic nosebleeds
8. A perforated septum
9. Hematoma
10. Burst blood vessels
11. Nervous damage

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

An eardrum rupture or perforation is a little gap or tear in your eardrum and the tympanic membrane. The tympanic membrane is a thin tissue that partitions the canal of the middle ear and outer ear. This layer vibrates when sound waves enter your ear. The vibration proceeds through the bones of the center ear. Since this vibration allows you to listen, your hearing can be affected if your eardrum is harmed. A ruptured eardrum is additionally called a perforated eardrum. Permanent hearing loss could be an end result in some cases.

A ruptured eardrum, similar to thunder; can happen all of a sudden. You may feel a sharp pain in your ear, or an ear infection that you've had for some time all of a sudden leaves. In some cases, the person may not feel any signs of the rupture.

Some of the causes for such a perforation are:

1. Infection: Ear infections are a major reason for eardrum rupture, particularly in children. Liquids tend to deposit behind the eardrum in such cases.
2. Exercises: Exercising can bring about pressure changes in the ear and lead to a punctured eardrum. This is known as barotrauma, and takes place when the pressure outside the ear is not the same as the pressure inside the ear. Activities that can bring about barotrauma include scuba diving or flying on plane.
3. Other activities: Wounds can likewise burst your eardrum. Any injury to the ear or side of the head can bring about a crack.

Diagnosis: Your specialist can use a few approaches to find out whether you have a ruptured eardrum:

1. A liquid test in which your specialist tests liquids that might spill from your ear from infection.
2. An otoscope exam in which a specific gadget with a light is used to investigate your ear channel
3. An audiology exam, in which your specialist tests your listening to range and eardrum limit.

Treatment: The treatments are as follows:

• Patching: In the event that your ear does not recuperate by itself, your specialist may fix the eardrum. Fixing includes setting a sedated paper patch over the tear in the film.
• Antibiotics: Anti-toxins can clear up contaminations that may have prompted your eardrum break. They additionally shield you from growing new diseases from the aperture. Your specialist may endorse oral antibiotics or eardrops.
• Surgery: In uncommon cases, surgery might be required to fix the gap in the eardrum. 

A cracked eardrum generally recuperates without any invasive measures. Many patients with cracked eardrums encounter just transitory listening problems.

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

What Causes Meniere’s Disease?
Meniere's Disease is a disorder that basically affects the sense of balance and hearing of the patient. This condition takes place in the inner ear and it may cause problems like vertigo, where patients experience a spinning sensation and a ringing sound as well. This is a chronic disorder, which requires a number of lifestyle changes so that it can be managed and treated without becoming a debilitating problem.

Read on to know more about the symptoms and causes of the condition.

Symptoms: The various signs and symptoms of this disease include a feeling of fullness in the ear, which has been affected by the condition. Also, most patients have a spinning sensation and a ringing sound in the affected ear. Nausea and vomiting may also be caused by this condition, along with sweating and loss of balance. It is also normal to feel uncoordinated when you are suffering from this condition.

Secondary Symptoms: This condition may also cause many other complications, which are known as secondary symptoms. These include anxiety, depression and stress. This usually happens due to the problems in the ear and even the problem of vertigo. This may cause problems for people who climb heights or ladders for their work or even for other recreational causes. The constant sense of dizziness and spinning may cause a person to become anxious and undertake stress when it comes to carrying out various kinds of functions in day to day living.

Causes: There are various causes of this condition, even though many medical reports suggest that the exact cause has not really been understood so far. As any doctor will tell you, the in the inner ear there is a labyrinth which contains fluids. When there is a problem with the composition and level of these fluids, the patient may develop Meniere’s Disease. This condition specifically affects the inner part of the ear. This part is made up of passages and a cavity as well as soft membrane like structures with hair like sensors. These sensors respond to the fluid’s movement within the ear. When this fluid does not have the appropriate levels, it can lead to many complications like Meniere’s Disease, which affect the nerve impulse that these sensors catch and transmit to the brain.

Stages: This disease progresses over a set of three stages. In the very first stage, the patient will experience much dizziness and nausea, before that progresses to the second stage. In this stage, the patient will have moderate to severe vertigo. This is also known as the middle stage. Finally, this may culminate into the third or late stage, which leads to more frequent episodes of vertigo. The hearing of the patient and the ringing sound in the ears will also get worse in this stage. If you wish to discuss about any specific problem, you can consult an Ent Specialist.

There is a strong connection between the ears, nose and throat, as any ENT or Ear Nose Throat specialist will be able to tell you. When there is any kind of congestion or obstruction in the nasal passages, one can also feel some effect in the ears with the symptoms going from mild to severe.

So how can nasal obstruction cause clogged ears? Here is our explanation!

1. The Connection: To begin with, let us understand the connection between the ears and the nose. There is an opening that can be found in the back of the nose, which leads into a tunnel called the Eustachian Tube. This tube goes into the ears and creates some amount of pressure when the nasal passages get blocked. This pressure can be felt as clogging of the ears and can usually be eradicated with the help of a pop in the ears. This pop can be brought about by pinching your nose and trying to breathe, or even yawning hard or indulging in some gulping or swallowing motion as well. 
2. Mucosal Swelling: The swelling within the patient's nose usually points at the buildup of mucus, which can make the nasal lining thicker, thus making the act of breathing that much more laboured and difficult. This obstructs the nasal tract, in plain and simple terms. This swelling usually spreads to the tunnel or the Eustachian Tube, which can become swollen and even shut, consequently leading to a feeling of having clogged ears. 
3. Negative Nasal Pressure: When the pressure inside the nose is built up in a negative way due to the obstruction that makes the patient breathe even harder, then the ears end up taking the pressure. This makes them clogged. This negative pressure usually manifests in the back of the nose where the Eustachian Tube is located, which creates a build up in the ears as well. This can also lead to a ringing pain when a patient tries to suck in air too hard due to the obstruction. 
4. Bernoulli's Principle: If we are to incorporate air in place of fluid and liken the action of breathing with an obstructed nose, with the action of sucking fluid in through an obstructed straw, then the fluid dynamics would apply to this case. As per these fluid dynamics, more rapid flow of fluid can lead to decreased pressure on the surrounding areas. This can be applied to the blocked nose where air must pass through faster and with more fluidity so as to ensure that there is less pressure on the ears, which will keep them from getting clogged. 

Persistent clogged ears and nasal congestion can also point towards an infection and should be checked by a doctor immediately. If you wish to discuss about any specific problem, you can consult an Ent Specialist.