Dr. Harmeet Singh Pasricha

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.

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.

An abnormal swelling in the neck can be symptom of various problems. While it can be something as non-threatening as a swollen gland due to a cold that can be cured with simple medication, a swollen neck can also turn out to be a cancerous lump in the neck. When faced with an irregular swelling in the neck, it is best to not panic or jump to conclusions until you consult with an Ear-Nose-Throat Specialist. The possible problems that a swelling in the neck can indicate are:

1. Swelling or enlargement of the salivary glands: The salivary glands may become enlarged due to an infection or due to foreign materials getting stuck in them. While foreign objects or formation of stones in the salivary glands might require surgical removal, they can often be dissolved with medication and other non-invasive treatments. And infection in the salivary glands is often treated with antibiotics or other medication. These treatments can be prescribed and administered by ENT Specialists.
2. Thyroid disease: The thyroid gland may swell up and cause a swelling of the neck. These are often called goiters in colloquial language and are a result of thyroid diseases such as hypothyroidism and hyperthyroidism. They usually require a series of medication and treatment and are not considered an ENT problem despite the swelling of the neck.
3. Benign cysts: Benign cysts can form in any part of the neck or in the glands, much like it can form in any part of the body. An ENT Specialist can prescribe a surgical removal of the cyst lest it turns cancerous later in life. It should also be removed in case it grows or relocates, going on to cause other problems.
4. Lumps in the muscles: Lumps in the neck muscles are formed by injury or torticollis. These usually aren’t considered ENT problems and can be treated by general physicians and sometimes chiropractors.
5. Cancerous cysts or growths: One of the most daunting problems posed by a swelling of the neck is the possibility of cancer. While thyroid cancers as well as cancerous growths in the salivary glands are slow to develop, a swelling in the neck should immediately be investigated by an ENT Specialist in order to rule out all possibilities. 

Nosebleeds are a common occurrence, and may indicate a severe medical condition. The rupture of the blood vessels within the front and back of the nose can cause such bleeding. These blood vessels are very tender and, thus, bleed easily.

There are two kinds of nose bleeds: namely anterior and posterior nosebleeds.

An anterior nosebleed occurs when the blood vessels at the front of the nose break or rupture, giving rise to bleeding. A posterior nosebleed is when the rupture takes place in a deeper part of the nose. The latter is more dangerous because blood can flow down the back of the throat.

Some of the causes of nose bleeding are:

- Trauma to the face, such as a punch on the face
- Repeated bouts of nose picking or irritation can also cause nosebleed
- Although rare, inability of the blood to clot can also cause the nose to bleed
- High blood pressure can also be a contributing factor

According to some people, cold can cause your nose to bleed. This holds true to an extent. Among the many reasons that can cause the nosebleed, summers serve as one.

This is because:

- Summer months are dry and hot, both of which are bad for your nose. The protective coating of mucus present within the nasal cavity can get dry due to low humidity in the hot months. The loss of the mucus causes your nasal cavity to be prone to dryness, leading to subsequent bleeding.

- The heat also has another damaging effect, as summers tend to intensify allergy, and an allergic reaction can cause nosebleeds.

Washing your nose with cool water and avoiding being subjected to direct sunlight may help to prevent nosebleeds. If you wish to discuss about any specific problem, you can consult an Ent Specialist.

Causes, symptoms and Treatment of Paranasal Sinuses

Hello, I’m Dr. Harmeet Singh Pasricha. I’m a senior ENT consultant practicing in Gurgaon. I graduated from the prestigious Armed Forces Medical College, Pune, and I did my specialization from New Delhi. Since 2010 I’ve been practicing in Gurgaon. I have my own clinic, Dr. Pasricha’s ENT and Eye Care Centre, Old Jail Land Complex, Sohna Adda, Gurgaon. And I also practice at Columbia Asia Hospital Palam Vihar, Gurgaon. So today I will be talking about nose paranasal sinuses, and allergies associated with it, and the diseases associated with nasal sinuses, specially the nasal polyps. So nose is one of the sense organs of our body. It is responsible for the sense of smell for patients. And it also plays a major role in the facial appearance, aesthetics of the patient person’s face. So the sinuses are hollow spaces inside the bones of the face around the nose. See this is the normal anatomy of the sinuses.

Cheekbones are hollow, which has got sinuses, and other also bones in the forehead contain the sinuses. These sinuses are normal structures of the body, and they’re connected to the nose through small air passages. Because of allergies and inflammation, then these connections of the openings of the sinuses of the nose get blocked, then the patient gets problems like sinusitis. And other problems associated with this are kind of allergies nasal polyps, which are overgrowth of the mucosa of the lining of the sinuses.

These days these are medically treated as allergies if development of polyps is there. Then we have to go in for endoscopic sinus surgeries for removal of these sinuses. So with the development of the endoscope, there is no cut outside on the skin, everything is done through endoscope in the operation theatre, through the nose. And we can clear the polyps, and the sinus can be treated with this condition. And medical management also has to be done after the surgery, and most important is the endoscopic follow-up in the OPT, every 6 months after the sinus surgery, to prevent any recurrence of the disease, and to check for requirement of any surgeries later on.

So for anything detail regarding this you can contact me at my clinic at Columbia Asia Hospital Palam Vihar, or you can even contact me online through Lybrate. Thank you.