alaknanda RE with additional Optima SMS “S GD &C F amily HealthOptima a w T AR” t ORPORA orld - A wider coverageforentirefamily Highligh health o 56677|www Single of bene TE OFFICE:1,NewT The HealthInsur pr ts of Sum ot fits. ection Come Insur « « « « Aut Anas In-pa Single Suminsur Eligibility - .s plans. Single protection, t ed arhealth.in |T check oma thetis tien Plan ance Specialis ank Str tic R And t hospit

An it t ’ s &Specialis es out. tha y per fr t eet, V om or t ed f aliz son ag a c tion ofSumInsur oll Fr incr ov a or en alluv tion c er t ed betw lif y wher Y ee: 18004252255 easing t f s our our tir ar K e, ees ov y e f our St er ot happiness e f een 5mon amily amily « ar y t « y am HighR our Cos en ou Insur Nur ed oncethelimitofc tir « t ofmedicinesanddrugs dr pr is sing e e Pr ths and65y a emium ance y w e &P f amily is. our oad, Nung y xpenses our T os o pr heart . ensur t hospit t esen oo! It s ear tr sa « eng s r The ambakk bea ts e v Sur esiding inIndia aliz es ov y th a our g bes t. er a eon’ unique y tion c fr P ou ag It's e om. am, Chennai600034 t happiness r e is s &Consult is, s o fr y ov n it om our a And er xhaus F l &C c amily omes t lif aking a it's r eline. t i ed an s n t g loaded Health a wher t ’ y s f s new ees It's Insur Health f or e ance

Insurance is the subject matter of solicitation The HealthInsur Health Insur ance Specialis Holistic ENT Car e v en mor t e bett ance gets e P e r s o er n a l &C a . r i n g Print Insur Health ed Matt ance er 01 Message from CMD About Your Company Foreword 02 India's First Standalone Health Insurance 03 0Allergy in ENT Company has begun its operations in May 2006. 06 Voice Disorders Message from CMD 09 Deafness in Children 14 Adenotonsillitis STAR HEALTH INSURANCE PRODUCTS: = FAMILY HEALTH OPTIMA 17 Sleep Disorders = ACCIDENT CARE 20 Head and Neck = MEDI CLASSIC INSURANCE Preserve the power of self healing 24 = STAR TRUE VALUE INSURANCE Agada Lifestyle 26 = STAR SUPER SURPLUS INSURANCE

27 Fungus in Sinus = STAR TRAVEL PROTECT 29 Discharging Ear = STAR STUDENT CARE INSURANCE 32 Sinusitis = MICRO HEALTH INSURANCE 37 Swallowing = STAR NET PLUS INSURANCE 39 Tinnitus – Management = STAR SENIOR CITIZEN RED CARPET POLICY My dear policyholder, 43 Fitness Section = DIABETES SAFE INSURANCE = STAR HEALTH GAIN The current issue covers the topic on diseases related to ENT. 46 Recipe Corner = STAR CRITICARE PLUS 47 Free Expert Medical Consultation You will kindly observe that the articles contributed by = STAR SHRI INDIVIDUAL CARE

Publisher: = STAR SHRI FAMILY CARE eminent Doctors will serve as a guide book for whomsoever Mr. V. Jayaprakash = STAR UNIQUE HEALTH INSURANCE POLICY when needed. As usual we function for your comfort and we Designed & Printed by: = STAR WEDDING GIFT POLICY Alaknanda Advertising Pvt Ltd Many more to come.... are always open to receive your communication about any 4/III Flr, City Centre Plaza 3, Mount Road, Chennai - 2. Star Health Advantages deficiency in our services.

Chief Editor: = A user friendly website with Health tips. Dr. Asiya Shahima Khan = A full-fledged 24X7 Call Centre with a Toll-free With your kind support, I am sure, your company will grow facility (1800 425 2255) for effective claims Editorial Board Members: handling. further and will always stand by your side to serve you. Dr. S. PRAKASH = Free General Physician Consultation over phone. Dr. C.B. KRISHNA KUMAR Doctors on duty 24X7. By quoting the policy number, Dr. S. KRISHNASHANKAR any person can contact our doctor for medical Dr. JEBA VICTOR advices. Corporate Office Star Health and Allied Insurance Company Ltd V. Jagannathan #1, New Tank Street, Valluvar Kottam High Road Chairman-cum-Managing Director Nungambakkam, Chennai – 600034 Email: [email protected] “ALL ABOUT KIDNEYS” LOOK OUT FOR THE INFORMATION IN OUR NEXT ISSUE FOCUSING ON KIDNEY...

Health Health 1 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Season of sneezes Foreword and runny nose Allergy in ENT

Prof. MOHAN KAMESWARAN Madras ENT Research Dr. KIRAN NATARAJAN Foundation, Chennai D.N.B., D.L.O., Madras ENT Research Foundation (MERF), Chennai

ENT is a specialty with common ailments which affect one and all. No single llergy is the reaction of a healthy subject individual can live a life without suffering from an ENT ailment at least once a year. to an unhealthy environment. The No family exists without an ENT disease. Around one out of six patients attending A immune system is hypersensitive to a any Government Hospital, will be having an ENT complaint and at least 20% of the potential invader (allergen). The incidence symptoms encountered by the Pediatrician, is directly or indirectly related to ENT of allergy is increasing due to modern lifestyle ailments. and afflicts 30 – 40% of the population. In spite of substantial and path-breaking advances made in recent times in the 4 While people may have a genetic predisposition to allergies (atopy), there are Fig.2: Fungus Fig.3: Pet Dander medical field, it is not uncommon for a doctor to see patients with misconceptions, several environmental triggers. Manifestations of allergy vary from person to unscientific convictions and firm but wrong beliefs about ENT diseases. This issue person. The commonest system to get affected is 4 Irritants in the atmosphere like cigarette tries to address many of the common ENT complaints in a simple, lucid and the respiratory system resulting in nasal allergy smoke readable fashion. The contributors are all surgeons of great repute, who have vast (allergic rhinitis) or asthma. Rhinitis is a swelling experience in dealing with a myriad of ENT disorders. They have put in their best 4 Chemicals of the mucous membrane of the nasal passages efforts to update the readers with a comprehensive overview of the spectrum of 4 Temperature changes due to irritation. (Fig.4) The immune system ENT diseases, current management trends and preventive measures. reacts to the allergen by production of protective 4 Strong smells It is my hope that this issue will go a long way in addressing the common concerns a n t i b o d i e s c a l l e d of many individuals with ENT ailments and at the same time will provide an avid 4 Stress immunoglobulin E and the release of several scientific insight into their prevention and management. 4 Other factors may provoke rhinitis in people susceptible to allergies. Dust mites are very c h e m i c a l s s u c h a s common allergens and feed on organic histamine which result material. in all the symptoms of allergic rhinitis. The s k i n ( a l l e r g i c d e r m a t i t i s ) , e y e s (allergic conjunctivitis), and gastrointestinal tract may get affected. (Fig.5)

Fig.1: Cockroach Fig.4: Allergic Rhinitis

2 Health Health 3 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. in the ear). Ear infections occur due to blockage can affect a child's appearance. sneezing and itching. Topical decongestants Irritable mood, depression, Stuffed nose, runny nose, poor sleep, memory problems, sinus pain or pressure, of the Eustachian tube, which connects the (nasal drops) may be helpful in reducing reduced alertness, headache nasal crease, nosebleeds, Allergy is diagnosed by a thorough history taking, post-nasal drip, lost sense of smell or taste middle ear with the nasopharynx (back of the symptoms such as nasal congestion but should Watery eyes including a family history as allergic tendency has under-eye cirlces Arched palate, swollen lips, nose). not be used for long periods as they can lead to a overbite, toothache, canker a genetic component. Endoscopy of the nose Hearing blockages sores, bad breath Fig. 9: Fluid in the middle ear secondary to nasal blood tests such as eosinophil count or Radio rebound nasal congestion and are associated Coughing, wheezing with side effects if used for prolonged periods. Sore or scratchy throat, allergy Allergo Sorbent Test (RAST) which measures the swollen glands The newer generation drugs for allergy have the Rashes quantity of specific antibody to a particular Allergy is a trigger for asthma. The chemicals advantage that they cause negligible drowsiness Ezcema antigen (allergen) may be required. A skin test is which are released on exposure to an allergen in comparison to previously available drugs. can cause severe irritation, itching, swelling and a simple test for detecting reaction to specific Belching bloating, Corticosteroid nasal sprays reduce inflammation heartburn allergens. spasm of muscle leading to tightening of the and are extremely effective in relieving the lungs resulting in asthma. More than 40% of Management of allergy; present day symptoms of nasal allergy. Immunotherapy may patients with allergic rhinitis have symptoms of scenario: be given to people over seven whose Fig.5: Allergic manifestations involving various systems of the body asthma and uncontrolled nasal allergy may Allergy can be managed effectively allergies are severe and do not respond cause worsening of asthma. and a person suffering from to medication and allergen Anaphylaxis is severe allergy causing a catch in allergies does not have to suffer a v o i d a n c e . I m m u n o t h e r a p y the throat, breathing difficulty, swelling of the life long from this problem. The involves exposing the allergy eyes, lips and face and may be life-threatening goal of treatment is to reduce sufferer to substances to which he unless treated immediately. However, the chronic a l l e r g y s y m p t o m s . T h e / she is allergic in gradually form of allergy is fortunately more common. A treatment of allergic rhinitis increasing concentrations. The patient with allergy involving the ear, nose and consists of three major immune system then becomes throat may have runny nose, frequent or categories of treatment: t o l e r a n t t o t h e a l l e r g e n . repetitive sneezing, nasal blockage, postnasal environmental control measures, Immunotherapy is commonly used in drip, cough, facial pain, nasal bleed, loss of smell, and allergen avoidance, medicines patients suffering from allergic rhinitis, sore throat, hoarse voice, itchy eyes, and boggy and immunotherapy. In mild allergic allergic asthma or insect allergy, if the swellings under the eyes. Tissue swelling in the rhinitis, reducing exposure to allergens may be allergen cannot be avoided. Although expensive, nasal passages, nasal polyp formation, sinus sufficient. For dust mites, covering the mattress patients may eventually save money on obstruction and sinusitis may occur. Migraine and pillows with impermeable covers helps medications. Currently immunotherapy is headaches may be triggered by nasal allergies. reduce exposure. Bed linens should be washed available as Sublingual Immunotherapy (SLIT) Fungus is a ubiquitous inhabitant of our planet. frequently in hot (atleast 130oF) water to destroy where in the administration is by oral route and (Fig.6) Allergy to fungus can result in a sinister the mites. Wet mopping of the home, using there are no injections involved. It is safe, long disease called allergic fungal rhinosinusitis vacuum cleaner & air conditioning and avoidance lasting and reduces the severity and frequency of (AFRS), (Fig.7,8) which if left untreated may be of carpets can significantly reduce allergen attacks. Self administration reduces the life threatening because of its tendency to erode levels. Exposure to non-specific triggers such as necessity of trips to the hospital. Surgery may be bone and spread outside the sinuses. The smoke, strong perfumes, and scents, rapid needed for certain causes of mechanical disease can spread from the nasal passages and changes in temperature, fumes and outdoor obstruction such as nasal polyps and sinusitis. A

sinuses into the eye and brain. Fig.8: CT scan of a patient with allergic fungal rhinosinusitis pollution must be avoided or reduced. In patients new class of drugs to modulate allergy may be in whom these measures are not effective, available in the near future. medication such as decongestants and Thus though allergic diseases may be the antihistamine tablets relieve nasal congestion, Allergies may be a mild inconvenience for some modalities and management is keeping pace. people while in others it can significantly affect the quality of life. Since 80% of allergy sufferers

Fig.6: Aspergillus (fungus) Fig.7: Allergic fungal rhinosinusitis are less than 40 yrs of age, allergy can have a significant impact on productivity. Allergy can affect a child's sleep, concentration, hearing, Allergy can also affect the outer ear (external appetite and growth and can cause learning otitis) and middle ear (middle ear effusion or fluid difficulties and fatigue. Chronic nasal obstruction

4 Health Health 5 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. VOCAL NODULES (Singer's or Teacher's undertaken in conjunction with behavioral Nodule) measures in order to be effective, and in Nodules are symmetric, broad-based masses consultation with a physician. which occur at the midpoint of both vocal folds. It Dr. S. ANAND KUMAR is a fact that nodules are found almost exclusively M.S., D.L.O, in young women and pre-adolescent boys, which Madras ENT Research Foundation (MERF), Chennai suggest that laryngeal size, may also be a factor that predisposes to nodule formation. It is a These conditions usually cause the subtle known problem of professional and amateur changes in voice like hoarseness, voice breaks, singers. Nodules generally cause painless Voice limitations in changing the pitch and loudness, hoarseness. People with vocal nodules typically voice fatigue or discomfort and deterioration with find their voice worse after cheering at a game, or Disorders Fig. 4: Redness and swelling of both the vocal cords and the prolonged use, and constant throat clearing. an evening out with friends, or a strenuous vocal surrounding area in LPR Since the voice is used by different individuals to performance. Voice rest and voice therapy is the LARYNGITIS meet different demands and situations, m a i n s t a y o f t r e a t m e n t f o r n o d u l e s . treatment for voice disorders varies depending Microlaryngoscopic surgery may occasionally be Laryngitis means inflammation of the vocal on the cause. Most voice problems can be needed for those not recovering with voice cords. Symptoms of Laryngitis are hoarseness successfully treated when diagnosed early. therapy. that gets worse with voice use and pain in the Some common voice related conditions are throat. Sometimes there may be fever and detailed below: cough. Initial measures to treat laryngitis are largely a matter of common sense: voice rest and VOCAL CORD CYST stay well-hydrated. In most cases, this will be A cyst is a mass made up of a collection of enough to shake off a viral infection. If there is a material, usually mucus that is surrounded by a cough that produces a yellow - or green - colored membrane. Cysts occur at the midpoint of the sputum, or a coating in the back of the throat, vocal cord, which suggests that the physical there may be a bacterial infection that warrants stress resulting from voice use, may contribute to Fig. 3: Vocal Nodules antibiotics. nspite of the advances in modern their formation. Cysts are not precancerous or LARYNGEAL CANCER technology, the very essence of cancerous lesions. They are important purely LARYNGOPHARYNGEAL REFLUX I effective human communication and because of their effect on the voice. Voice rest is Laryngopharyngeal reflux (LPR) describes the Laryngeal cancer, like other cancers, is a change emotion, is conveyed through the spoken often prescribed in cases of hoarseness, may backward (upward) flow of digestive acid and of normal tissue to tissue that grows word. Like fingerprints, every single individual's improve the voice somewhat, but is not likely to enzymes from the stomach through the uncontrollably. The first symptom is change in voice is unique, which gives quality and depth to make a cyst go away. Voice rest serves to soften esophagus to the level of the vocal folds. Reflux voice. Laryngeal cancer is one which can be our personality. It plays a vital role in mankind's and dissolve associated swelling, but the cyst is significant because the acid and enzymes that diagnosed early and treated completely. progress. Thus depending on one's age and itself will not usually shrink. A cyst must be reach the larynx cause injury and irritation. The Smoking is responsible for the overwhelming profession our voice plays a big part in who we r e m o v e d s u r g i c a l l y b y m e a n s o f larynx is damaged by contact with stomach majority of laryngeal cancers. Alcohol intake will are, in what we do and how we communicate. microlaryngoscopic surgery. fluids. Reflux causes irritation and swelling of the aggravate incidence of Laryngeal cancer. Laryngeal cancer can occur occasionally in Any condition that affects the performance of the larynx. It represents a problem that must be nonsmokers also. voice-producing organ – the larynx can cause a controlled through dietary measures and Voice disorder. The most common conditions sometimes medication. Food which is greasy, fatty or very sugary tends to make reflux worse, 4 Cyst as does alcohol, caffeine and nicotine. In addition 4 Polyps to avoiding specific foods, it is important to eat 4 Nodules smaller meals, and to eat earlier, at least three hours before lying down to sleep. In severe 4 Reflux laryngitis and cases, particularly when there are nighttime

4 Cancer Fig. 1: Left Vocal cord cyst symptoms, raising the head of the bed may be helpful. Medical treatment of reflux should be Fig. 5: Laryngeal Cancer

6 Health Health 7 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. The treatment options for a laryngeal cancer are This investigation is also an outpatient procedure determined by its size and extent. Laryngeal after a local anesthetic. This gives much more cancer may be treated by means of radiation, precise information about the movements of the surgery, chemotherapy, or a combination of vocal cord. D AFNESS these. VOCAL HYGIENE in LARYNGEAL PAPILLOMA 4 Increase fluid intake: optimal is 2.2 liters A papilloma is a warty growth of the larynx (women) 3 Liters (men) per day. CHILDREN caused by a virus. Different types of the same 4 Avoid excessive or frequent throat clearing Current Status in Diagnosis family of viruses cause similar growths try sipping water instead. and Management elsewhere in the body. The papilloma virus is probably transmitted from person to person by 4 Frequent throat-clearing or coughing can be intimate contact. Some people may carry the injurious to the vocal cords. virus unwittingly without developing symptoms, 4 Excessive cough, mucus production, or Dr. RAGHUNANDHAN so understanding transmission is not straight throat clearing may be an indication of an forward. u n d e r l y i n g d i s o r d e r s u c h a s M.S., D.N.B., MRCS, DOHNS Consultant ENT Surgeon, VOCAL FOLD PARALYSIS Laryngopharyngeal Reflux. Madras ENT Research Foundation (MERF), Chennai The paralysis is immobility of a vocal cord 4 Get plenty of sleep. Fatigue can cause the because of damage or dysfunction of its nerve voice to sound hoarse. supply. This nerve travels from the brain down the 4 Use plenty of breath support. Your lungs are neck and into the chest before turning upwards the generator of the voice. Take advantage of Introduction back to the larynx. So the same can be damaged them. anywhere in its long route. This can be unilateral he sense of hearing is perhaps the most 4 Do not speak in sentences that are too long. (one-sided) or bilateral (two-sided). The important of all the five special senses This causes you to vocalize with inadequate treatment depends upon the cause. T w h i c h w e h u m a n s p o s s e s s . breath support at the end of your air stream. Unfortunately, deafness is a silent Investigations done to identify Voice Shorter sentences with a deep breath in handicap, with millions of people in India Disorders between optimize breath support. suffering from varying degrees of hearing VIDEO LARYNGOSCOPY 4 Minimize caffeine, alcohol and dairy intake. impairment. Loss of hearing in childhood results This is an efficient method to examine the larynx These can dry out the vocal cords and/or in a double tragedy since it leads to delayed and to plan further treatment. This is an out create thick mucus. speech and language development. The end patient procedure done in a sitting posture after a 4 Avoid menthol throat lozenges. These can result of congenital deafness is a “Deaf and local anesthetic. This gives a gross appearance dry the throat. Dumb” individual living within his deaf world, with of the entire larynx. no means of verbal communication. 4 Avoid smoking. STROBOSCOPY 4 General awareness level among public to 1. Sound moves through the ear canal and strikes the eardrum. 4 Be aware of background noise. Raising your 2. Sound waves cause the eardrum to vibrate, sending the bones in the middle ear recognize loss of hearing at the earliest and into motion. voice above others in a loud environment seek appropriate medical help needs to be 3. This motion causes the fluid inside the inner ear (cochlea) to move the hair cells. can cause straining and vocal abuse. 4. Hair cells change the movement into electric impulses, which are sent to the increased. hearing nerve into the brain; you hear sound. 4 While speaking, if there is throat discomfort, 4 Initiatives like Government's Health pain, vocal fatigue or experience "cracking" Department 'National Program for Hearing impairment occurs due to abnormalities of the voice, consult your laryngologist. Prevention and Control of Deafness' – in the structure or functioning of the outer ear, Thus the human voice should be given due NPPCD are welcome. middle ear, inner ear or the auditory pathways. respect and necessary treatment initiated in case 4 As per the recent WHO report, India has a Deafness is therefore classified as conductive, of voice disorders, in order to communicate population of over 1 billion, of which nearly 3 sensorineural and mixed. A good history, clinical effectively. million children are affected by deafness of examination and full audiological evaluation is varying degrees. Every year around 25,000 essential to determine the cause of deafness. children are newly diagnosed with deafness. The management of hearing impairment in Fig.7: Stroboscopy

8 Health Health 9 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. children depends on the cause and it may require 4 Signs of delayed speech & language syndromic associations, children born with by charitable trusts (eg: MERF Charitable a multidisciplinary team including the ENT development are a strong indicator of hearing hearing impairment are also routinely evaluated Trust), Philanthropists, bank loans and well Surgeon, Pediatrician and Audiologist. loss in children by an eye specialist prior to implant surgery and wishers, but large scale funding is the SENSORI-NEURAL HEARING LOSS (NERVE 4 Detailed ENT history & examination is by a child specialist for immunization. need of the hour to implant, the huge number DEAFNESS) IN CHILDREN essential. A complete review of all organ The surgery of cochlear implantation is a of deaf children in India. Deafness is the commonest congenital anomaly systems for abnormalities suggesting a microscopic ear surgery done under general 4 Madras ENT Research Foundation (MERF) to affect the children in Indian sub-continent. syndrome should be performed anesthesia and usually lasts for 2 – 3 hours. It has been in the forefront of the Cochlear Incidence of sensori-neural deafness among MANAGEMENT OF SENSORI-NEURAL involves an incision behind the ear to open the Implant scenario in India with a series of more children is about 1:1500 to 1:2000 in the Indian (NERVE) DEAFNESS mastoid (bone behind the ear). After the surgery, than 400 implants till date. sub-continent. Around 50% of these children are the post-op course is usually uneventful and the 4 Today MERF has one of the largest Cochlear Till date the use of hearing aids formed the implantee gets discharged 72 hours after the born deaf & are not identified until about 18 mainstay of treatment even with significant Implant clinics not only in India, but in the months old, while 25% are still left undiagnosed procedure. Switch-on of the device is planned 3 whole of South Asia. The first series of Totally improvement; still there are children who do not weeks after implantation. The implantee has to at 3 years of age. Such late diagnosis can have a have any benefit from powerful hearing aids and Implantable Hearing Devices in this part of devastating effect on their speech and language visit the hospital periodically after the cochlear the world were also performed successfully these are the ideal candidates for receiving implant surgery for mapping and habilitation. acquisition, social skills & communication implantable hearing devices. With the at MERF last year. development, which can last a lifetime. Early and introduction of surgically implantable hearing Some implants take longer to fit and require more appropriate intervention is needed. Now the devices such as cochlear implants and brainstem training. Implant team will ask the individuals to technology has advanced to the level of implants, significant strides have been made in come back to the clinic for regular checkups and objectively determining a child's hearing status rehabilitation of hearing loss. This has been readjustment of the speech processor as within few hours after birth. Signs of delayed made possible due to new diagnostic and needed. All implantees have to mandatorily speech & language development are a strong treatment modalities and the development of undergo auditory verbal habilitation with well indicator of hearing loss in children. materials that are biocompatible. trained & experienced teachers, for a minimum period of one year after surgery. CONGENITAL (GENETIC) DEAFNESS COCHLEAR IMPLANTS Nearly 50% of sensori-neural hearing Cochlear implants in India Cochlear Implant (Bionic Ear) is an electronic 1. External speech processor captures sound and converts it into digital signals impairment in children is due to genetic factors 4 Available worldwide since 1980s. 2. Processor sends digital signals to internal implant hearing device, designed to produce useful 3. Internal implant converts signals into electrical energy. sending it to an electrode (congenital deafness). array inside the cochlea hearing sensations by electrically stimulating 4 However, in India, they were introduced in the 4. Electrodes stimulate hearing nerve, bypassing damaged hair cells, and the brain perceives signals; you hear sound ACQUIRED INNER EAR DEAFNESS nerves inside the inner ear. Cochlear implant 1990s. This is due to maternal ingestion of teratogens / bypasses the damaged hair cells of the cochlea 4 In the last decade, increasing awareness Ototoxicity, intrauterine infections (Rubella, (inner ear) and directly stimulates the nerve of regarding the benefits of cochlear implant Cytomegalic inclusion disease, Toxoplasmosis, hearing. It is useful in patients who have severe- technology has led to an increase in the Influenza, Herpes 1 and 2 & Syphilis), perinatal profound hearing loss in both ears (due to various number of cochlear implantees in India. causes such as prematurity, anoxia, kernicterus, reasons) and who do not benefit from hearing aids. 4 Only around 10,000 children have received ototoxic medication & meningitis. Maternal cochlear implants in India till date, while an alcoholism-nutritional disturbances, endocrine General Practitioners need to identify profound enormous number of approximately 1 million disease - maternal thyrotoxicosis, diabetes & deafness at the earliest and refer such children are affected with profound deafness immunologic disorders are also etiological individuals to an implant clinic for an evaluation. in our sub-continent. factors. The evaluation at the Cochlear Implant Clinic, will 4 The major factor deterring the use of this DIAGNOSIS OF SNHL IN CHILDREN be done by an implant team (an otolaryngologist and audiologist). Special X-rays are taken, advanced sophisticated technology to one Suspected hearing loss is to be evaluated early in usually computerized tomography (CT) or and all, is its cost factor. These implants are childhood. magnetic resonance imaging (MRI) scans, to manufactured abroad and need to be 4 Relevant family history evaluate the inner ear anatomy. The imported at a high price ranging from 6 to 10 anesthesiologist will give a comprehensive lakh rupees. 4 Birth history physical examination in order to identify any 4 Many needy children from the below poverty 4 Perinatal events potential problems with the general anesthesia line have benefitted with cochlear implants 4 Developmental milestones needed for the implant procedure. To rule out today, due to significant monitory aids given External and Internal components of a Cochlear Implant

10 Health Health 11 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Auditory Brainstem Implants CONDUCTIVE DEAFNESS mandatory for every child birth. This protocol Auditory Brainstem Implant is an effective means Conductive deafness occurs due to any lesion of is also advocated by our Central of hearing rehabilitation in candidates with the external or middle ear. Although there are Government through its 'National Program tumors involving both the nerves of hearing or several causes, the most common causes are for Prevention and Control of Deafness' and is being performed in leading hospitals absent nerves of hearing, where in a cochlear i. Otitis media with effusion and implant cannot be performed. The ABI allows across our country today. patients to experience improved communication ii. Chronic suppurative otitis media. In the near future, this technology should as well as access to environmental sounds. iii. Conductive deafness may also occur due to propagate onto all rural health centers and only congenital disorders such as Down's syndrome, then the real prevalence of congenital deafness Crouzon disease, Marfan's syndrome, Treacher in our one billion strong Indian population, would Collins syndrome, Pierre Robin syndrome, come to light. A Holistic effort by our Government, Apert's syndrome, Achondroplasia, cystic all our medical fraternity and our responsible f i b r o s i s , i m m o t i l e c i l i a s y n d r o m e , society, can make a remarkable transition in the mucopolysaccharidosis and cleft palate. lives of our deaf children, bring them out of the gloomy world of silence, onto the vibrant world of Otitis media in children may present in various Bone Anchored Hearing Aid sound. ways. The condition must be identified and treated early in order to prevent the long term CONCLUSION: present scenario sequelae and complications of otitis media. A 4 The importance of early detection and complete ENT examination and audiological & management of deafness in children cannot radiological work up is required. Otitis media be overemphasized. must be excluded in any child with delay in speech and language and behavioral problems. 4 Identification of the type and cause of deafness has to be done meticulously as Bone Anchored Hearing Aids successful management varies. Bone Anchored Hearing Aids (BAHA), are useful 4 Hearing loss is a double tragedy especially in in children with hearing loss due to absent outer the newborn, as it leads to not only deafness ear canals and chronic ear infections, who but also Mutism. cannot wear a conventional hearing aid. Sound is conducted through the skull bone bypassing the 4 Hearing loss is the only truly remediable outer and middle ear and stimulates the inner ear. handicap and the mantra is “Early detection and management”. The Auditory Brainstem Implant 4 Children born deaf must be brought to the ENT surgeon at the first suspicion of deafness to enable timely intervention. 4 In our society, preventable causes of deafness such as excessive noise exposure due to traffic, movie houses, crackers, loudspeakers and industrial noise must be addressed because noise damage is cumulative. 4 The problem of consanguinity (marriage between close relatives) resulting in children being born deaf and deafness running in families also needs to be addressed.

X-ray picture of a child with Auditory Brainstem Implant 4 The western world has made newborn hearing screening with OAE testing

12 Health Health 13 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. can also lead to Pediatric sleep apnea which is a growing problem both for the child and the parents as it can lead to poor school performance, disturbed sleep, irritability, snoring, mouth breathing, excessive daytime Adenotonsillitis sleepiness

Adenoids = Investigations: After a Complete ENT examination, Tonsil 1. Complete routine blood investigations 2. Anti-streptolysin O antibody titre 3. Throat swab if discharge is present 4. Pus culture and sensitivity if abscess is drained Dr. SHYAM SUDHAKAR 5. X-ray nasopharynx for adenoids M.B.B.S., (DNB) Madras ENT Research Foundation (MERF), Chennai 6. Absolute eosinophil count, Serum Fig. 1 IgE – allergy 7. Skin prick test - allergy hat is Tonsillitis & Adenoiditis? Usual Complaints : = Complications Of Adenotonsillitis: W Tonsils are lymphoid tissues located 4 Sore throat = Can be a source of infection which can in the Oral cavity (Fig.1) which 4 Frequent colds cause recurrent problems like upper provide immunity against infections in the upper respiratory tract infections 4 Nose block aero-digestive tract. Tonsils are similar in function = Huge obstructive long-standing adenoids to the Adenoids which lie behind the nose. 4 Throat pain if untreated can cause blockage of the Sometimes these adenoids and tonsil tissues get 4 Nasal discharge tube which connects the back of the nose infected and become inflammed when the 4 Fever to the middle ear (Eustachian Tube) leads diagnosis of adenoiditis and tonsillitis is made. to a collection of non - infective serous 4 Hearing problems fluid within the middle ear cavity. This When is it necessary to remove the tonsils? Does removal of septic tonsils / adenoids 4 Breathing problems like snoring and fluid gets organized like 'Glue' over time Recurrent septic infections of the tonsils not lead to reduced immunity in the body of the mouth breathing if huge tonsils and leading to conductive hearing loss and responding to a complete course of medications child? adenoids block the airway (Fig.2) blocking sensation in the ears. This (oral or intravenous antibiotics), should be condition is termed as Otitis Media with Removal of septic adenoids / tonsils due treated by tonsillectomy surgery. If a patient 4 Facial changes in long-standing cases Effusion' and this fluid needs to be to recurrent infection does not reduce the develops an abscess around the tonsils, then an 4 Difficulty in swallowing drained by a surgical procedure called immunity in the body of the child Interval tonsillectomy is done after a period of 6 Myringotomy with insertion of a weeks after the acute episode has subsided. 4 Cough Does Adenoids / tonsils recur after removal? ventilation / drainage tube – 'Grommet' in 4 Ear pain There is no scientific evidence that Causes: the ear drum adenoids / tonsils once completely 4 This infection can be caused by virus or = Huge obstructive adenoids can lead to removed will recur. After adenoidectomy, bacteria. Adenoids & tonsils can also be enlarged infection of sinuses, infection in middle allergy may rarely cause enlargement of due to nasal allergy ear with discharge of pus (suppurative the lymphoid tissue mimicking adenoid 4 It is usually seen in school-going age group otitis media) symptoms. But this is easily curable with anti-allerygic treatment 4 Transmission of infection is by air-borne = Enlarged Adenoids & tonsils in children

route due to coughing and sneezing Fig. 2

14 Health Health 15 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. N N N N = Management: N N = Medical N N N e = Antibiotics - oral / intravenous Sle p = Steroid nasal sprays = Local antiseptic gargles = Analgesics i o e s = Anti-histamines Ds rd r = Soothening agents = Plenty of warm fluids and hydration = Surgical – Septic adenoids / tonsils will be a continuous source of infection which may affect other organs of the body if the Dr. VIJAYA KRISHNAN organisms enter the blood stream, i.e. D.N.B., D.L.O., renal problems, skin infections, defects in Madras ENT Research Foundation (MERF), Chennai valves of the heart. So, the removal of s e p t i c a d e n o i d s & t o n s i l s What's New in Obstructive Sleep Apnoea Syndrome? (adenotonsillectomy) due to recurrent “The sufferers who doesn't suffer” infection provides great relief both for the My Husband's Snoring Is Ruining Our Marriage! patient and for the parents = Methods of Adenotonsillectomy noring & Sleep Apnoea is an increasing problem in our society. It affects 2 - 4% = Guillotine – done rarely S Adenotonsillectomy is an age old surgery which of middle aged adults and 1 - 3% of = Dissection – using sharp dissection with has undergone a revolution in recent times due to pediatric age groups. Significant advances knife latest scientific advances in technology and have been made since then in this field and the management protocols otolaryngologist must be familiar with the diagnosis and various methods of management = Conclusion: of sleep apnoea. Early diagnosis and treatment of septic Factors that reduce upper airway size or Adenotonsillitis / pediatric obstructive predispose to upper airway collapsibility increase the airway during inspiration because of sleep apnea can go a long way in helping the susceptibility to sleep apnoea. If untreated, partial blockage. both the patient and the family the patient is likely to suffer from deleterious 4 This is because our muscle tone is reduced effects on the cardiovascular system secondary during sleep and there may be insufficient to long standing oxygen deprivation. muscle tone to prevent the airway tissue = Recent Advances in dissection like the The sudden increase in patients noticed in recent vibrating. times represents an apparent increase due to following are also used in some centres 4 It is also common in children. more people seeking treatment because of = Laser ablation awareness as well as a true increase in the An Introduction to Apnoea incidence due to life style changes. 4 Apnoea is stoppage of airflow at the nostrils & What is snoring? mouth for atleast 10 seconds. 4 Snoring is defined as a coarse sound made 4 Obstructive Sleep Apnoea syndrome is a by vibrations of the soft palate and other condition in which 30 or more apnoeic tissue in the mouth, nose & throat (upper episodes occur during a 7- hour period of sleep. airway). What are the risk factors? 4 Snoring is caused by turbulence inside 4 Excessive consumption of alcohol

16 Health Health 17 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 4 Overeating and faulty nutrition Sleep MRI, a dynamic imaging modality helps to retropalatal and retrolingual airway. A thorough 4 Lack of exercise assess the site of obstruction whether it is behind evaluation is essential before decision for a the nose / palate / tongue. particular technique is made. No single 4 Smoking - Smokers are twice as likely to procedure works for all patients. snore as non - smokers Surgical treatment aims at increasing the space 4 It is more common in people with sedentary behind the tongue or palate according to the level life style of obstruction by removing the excessive tissue How do we diagnose OSAS ? 4 Unfortunately, the excesses of life's with LASER / Coblation or moving forward the Investigations are aimed at identifying if the jaw bone. pleasures are the main causes of snoring What are the treatment options available? and sleep apnoea patient has simple snoring or OSAS. If he has In the future, neuromuscular stimulation of the It depends upon the severity and underlying OSAS, the site and severity of obstruction must genioglossus muscle and direct stimulation of the 4 Fat deposits around the neck – “Double cause of the disorder. The treatment modalities be determined. Evaluation for OSAS starts with a hypoglossal nerve may be useful in the Chin” may be proper history taking including h/o alcohol, drugs management of OSAS. “Heroic snoring” is known to be a leading cause e.g. sedatives. Comprehensive ENT & head and 4 Medical appliances such as nasal splint, Is obstructive sleep apnoea dangerous? for divorce in the western world neck examination is done. The common findings mandibular positioning device, tongue noted are short thick neck, enlarged floppy uvula, retaining device Yes, In rare cases, apnoea can be fatal. But in elongated soft palate, tonsillar hypertrophy & general it takes away the quality of life. 4 Surgical - If anatomical obstruction is enlarged tongue. The presence of micrognathia / present, corrective surgery can be done Weight reduction, regular exercise and life style retrognathia is noted. Weight and blood pressure modification are the key to lead a successful life. are recorded. A general medical work up must be Medical management consists of advice on done to identify patients at risk for increased physical activity and weight reduction, cardiopulmonary complications including FBC, treatment of systemic disorders and advice on A middle aged man whose collar size is 17 ½" or ECG, chest X-ray, thyroid evaluation and lung alcohol abstinence. Mandibular positioning What's your Snore Score? above is predisposed to snoring. function tests. device in nonobese patients with micrognathia / 1. Are you a loud and / or regular snorer? retrognathia helps advance the mandible and What are the effects? Yes / No increases posterior airway space. It has a 2. Have you ever been observed to gasp or stop 4 Cardiac arrhythmias. success rate of 50 % & compliance rate of 25%. breathing during sleep? 4 Right-sided heart failure Continuous Positive Airway Pressure (CPAP) Yes / No 4 Hypertension is a noninvasive and highly effective primary 3. Do you feel tired or groggy upon awakening, or do treatment modality for OSAS. It delivers a you awaken with a headache? 4 Severe morning headaches continuous flow of air to stent the upper airway Yes / No 4 Daytime sleepiness from collapsing during sleep by increasing airway 4. Are you often tired or fatigued during the wake 4 Intellectual and personality changes Polysomnography (Sleep Study) is the gold volume, area and lateral dimensions in time hours? retropalatal and retroglossal regions. 4 MED – Men Erectile Dysfunction standard investigation for OSAS and involves Yes / No overnight monitoring of pulse oximetry, ECG, 5. Do you fall asleep sitting, reading, watching TV or 4 Heart attack EEG, anterior tibialis EMG, EOG, nasal & oral driving? 4 Sudden unexpected death airflow, chest & abdominal movements & Yes / No sleeping position. It helps to differentiate 6. Do you often have problems with memory or obstructive from central sleep apnoea and helps concentration? to evaluate the severity of the problem. Yes / No If you have one or more of these symptoms you are at Surgical treatment consists of eliminating / higher risk for having Obstructive Sleep Apnea. If you controlling the etiology of obstructive breathing. are also overweight, have a large neck, and / or have In children, surgical removal of obstructing tissue high blood pressure the risk increases even further. 4 Road Traffic Accidents (One study found that (adenoids and tonsils) is the most common If you or someone close to you answers “Yes” to any people with sleep apnea are 7 times more method of treatment of OSAS. of the above questions, you should discuss with your symptoms with your physician or a sleep specialist likely to be in a car accident than people There are many options for correcting the on the diagnosis and treatment of Sleep Apnea. without sleep apnea)

18 Health Health 19 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Estimated age-standardised mortality rate per 100,000 of developing cancers of the oral cavity, pharynx Larynx, Lip, oral cavity, Nasopharynx, Other pharynx: both sexes, all ages and larynx. There is a strong relationship between the quantity of alcohol consumption and the level of risk. Combined effects of smoking and alcohol consumption: D The combination of smoking and alcohol HE consumption increases the risk of developing cancer for all sites. GLOBOCAN 2008 (IARC) - 15.12.2010 Dietary factors : Common sites of Head - neck cancers: Poor diet is a risk factor for head and neck cancer. NECK Conversely, people with a good Mediterranean 1. Laryngeal cancer diet have less than half the risk of developing (voice box) At oral/pharyngeal cancer and half the risk of the level of vocal developing laryngeal cancer (results adjusted for cord, above and Dr. MAJOR. MOHAMMED DELWAR HOSSAIN smoking and body mass index; BMI). The key below vocal cord. SCPS, D.L.O., protective elements of the Mediterranean diet Maximum incidence is at Madras ENT Research include: citrus fruit; vegetables, olive oil and fish the level of vocal cord. Foundation (MERF), Chennai oils. An increase in N-3 polyunsaturates by 1 g 2 . Pharyngeal cancer (food passage). per week reduces the risk of oral cancer. 3. Cancer of the tongue, tonsil and palate. Diagnosis and Management Occupational hazards: 4. Oral cavity cancer includes cancer of floor of of Head -Neck Cancers Textile industry, carpet installer, those involved in the mouth, cheek, jaw, gums and palate. fossil fuel, semiconductor manufacturer and heavy mechanists are at increased risk of Clinical presentation with Head - Neck ntroduction DANGER POISON ! I developing head & neck cancers. Cancers requires early referrals: Acetone (solvent) Cyanhydric acid (was used in the gas chambers) Gastro esophageal Reflux disease: 1. Red and white patches of the oral mucosa he head and neck region is one of the *Naphtylamine Ammoniac Methanol which persist for more than three weeks. cancer prone areas of the human body. (detergent) (used as rocket fuel) There is evidence to suggest that the presence of *Urethane T The incidence of disease has tended to *Pyrene Toluene gastro-esophageal reflux disease (GERD) is a 2. Ulceration of oral mucosa or oropharynx Naphtalene (industrial solvent) increase with age and most of them are in (moth-repellent) risk factor for laryngeal and pharyngeal cancer. which persists for more than three weeks. Arsenic Nicotine people aged over 50 years. There is now (lethal poison) (used as a herbicide and insecticide) Genetic Factors: 3. Oral swellings which persist for more than evidence that the incidence of head and neck *Dibenzacridine *Cadmium *Polonium 210 three weeks. cancers in increasing amongst young people of (used in batteries) (a radioactive element) There is evidence to suggest a genetic Carbon monoxide (found in exhaust fumes) DDT 4. Unexplained tooth mobility not associated both sexes. The patient with early disease stands (insecticide) susceptibility to head and neck cancer. At present Vinyl chloride with periodontal disease. a better chance of cure and increased survival. (used in plastic materials) *Known carcinogenic substances there are no valid genetic screening tools for Unfortunately many patients with head - neck STOP SMOKING ! Head & Neck cancers. 5. Persistent, particularly unilateral, discomfort cancer present at a late stage although, Oncogenic Virus: in the throat for more than four weeks. improved survival for patients may be achieved Smoking and Tobacco: with rapid detection and treatment. This chapter Certain viruses seem to have a causal 6. Pain on swallowing persisting for three Smoking is a risk factor for all tumour sites follows the patient's journey of care from relationship to Head & Neck cancers. Human weeks that does not resolve with antibiotics. covered by this guideline. Leaving a cigarette on presentation and awareness through treatment papillomavirus (HPV) 16 sero-positivity is 7. Difficulty in swallowing which persists for the lip is predictive of lip cancer risk irrespective to follow up and rehabilitation. The treatment associated with an increased risk of oral / more than three weeks. of cumulative tobacco consumption. pharyngeal cancer. Epstein Barr Virus is sections focus specifically on cancers of the 8. Hoarseness which persists for more than Chewing tobacco is a risk factor for cancer of the associated with Nasopharyngeal carcinoma. larynx, oral cavity, orpharynx, and hypo pharynx, three weeks. as these are the tumor sites with the highest oral cavity. Ionizing radiation: 9. Difficulty in breathing (requires same incidence. Alcohol consumption: Ionizing radiation has been reported to cause day referral). Risk factors for Head - Neck cancers: Alcohol consumption strongly increases the risk cancer of the head and neck region.

20 Health Health 21 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 10. Unresolved head or neck mass which 2. A medical oncologist. Chemotherapy can be administered in follow up and dental rehabilitation persists for more than three weeks. 3. A radiologist. combination with definitive surgery or 4 Dental extractions in irradiated jaws radiotherapy as follows: 11. Unilateral blood stained nasal discharge 4. A pathologist. should be carried out in hospital by a Dentist. which persists for more than three weeks. · 4 Neo-adjuvant - delivered in the weeks 5. A speech and language pathologist. b. Speech and language therapy: 12. Facial weakness or severe facial pain or before surgery or radiotherapy. 6. A clinical nurse specialist. Head and neck cancer patients with dysphagia numbness. 4 Adjuvant - following surgery or should receive appropriate speech and language 13. Orbital (eye) masses. 7. A dietician. radiotherapy. therapy to optimize residual swallow function and 14. Ear pain without evidence of local ear Treatment of the Primary cancer: 4 Concurrent - with radiotherapy. reduce aspiration risk. All patients undergoing Treatment of the Neck Nodes: chemoradiation should have access to a specialist abnormalities. A. surgery: speech and language therapist before, during and Clinical assessment for Head - Neck Cancers Surgery may be the treatment of choice if the after treatment. primary cancer can be excised with an appropriate 1. Detail history of the disease process. c. Dysphagia: margin of normal tissue without resulting in major 2. Physical examination by an experienced functional compromise. Whenever possible, Head and neck cancer patients with dysphagia clinician. surgery for a primary head and neck cancer should should receive appropriate speech and language 3. Fiber optic endoscopy. preserve organ function. therapy to optimise residual swallow function and reduce aspiration risk. 4. FNAC (needle aspiration) of the suspected 4 Where necessary, surgical resection Image made available by a generous grant from Bristol - Myers Squibb masses. should be followed by reconstruction using d. Communication: The neck contains more than 600 lymph nodes the most appropriate technique. Patients undergoing laryngectomy should have 5. Complete Endoscopic examination of the draining various vital structures of the head and specialist speech and language therapy to restore airway and food passage. 4 Non-surgical treatment (radiotherapy with neck. A primary cancer from any of these regions can voice either by a tracheoesophageal voice 6. Biopsy from the suspected lesion. or without chemotherapy) should be spread onto these lymph nodes or a primary cancer offered to patients if survival rates are prosthesis and / or oesophageal speech. 7. Barium study of upper gastro intestinal tract. of the lymph node itself can manifest in the neck (eg: comparable with surgical resection. Lymphomas). Appropriate diagnostic measures E. Nutritional support: 8. Imaging study - CT Scan, MRI, PET - CT. 4 Salvage surgery must be available if an need to be performed to identify the location of the Early nutritional intervention, either by 9. FDG PET - CT scan to rule out distant organ preservation approach is to be primary cancer and address the involved lymph gastrostomy tube or by nasogastric tube feeding, metastases. pursued. node according to its staging. Cancers which and ongoing nutritional support for patients with manifest with lymph nodes in the neck have to be 10. Genetic and molecular analysis - PCR / In 4 Following surgical resection of the head and neck cancer impacts on treatment treated either with external beam radiotherapy to situ hybridization. primary cancer adjuvant postoperative outcome and quality of life. radiotherapy should be considered where address the neck nodes or surgical intervention 11. Immunocy to chemistry. F. Patient support: indicated. with a radical neck dissection. 12. Tumor markers. E. Follow up, Rehabilitation and patient support: There is evidence that patients with head and B. Radiotherapy: neck cancer suffer from anxiety, depression, Overview of treatment of the Primary cancers Treating cancers with ionizing radiation Follow up: Patients should be seen frequently disturbance of body image and difficulty in and Neck: and regularly within first 03 years post treatment as maintaining quality of life. The complex needs of Radiotherapy can be delivered with - The aim of treatment is to maximize locoregional maximum recurrence occurs within the first 02 years patients with head and neck cancer require control and survival with minimal resulting functional 4 Curative intent: (Radical radiotherapy) post treatment. Patient should be offered psychological support to address the problems they multidisciplinary follow up. Patient's weight should damage. The most important function that must be 4 In order to improve local control following may encounter. be monitored & Patient's complaints of pain should considered when planning treatment are: surgery (Adjuvant radiotherapy) be investigated. Conclusion 4 Swallow 4 Or to provide symptomatic relief only 4 Rehabilitation: Head and neck cancers account for 4 Respiration and (palliative radiotherapy). approximately 3-5% of all cancers in the body. a. Oral and dental rehabilitation 4 Speech C. Chemotherapy: Tobacco and alcohol use are the most important risk · Patients receiving oral surgery or factors for the head- neck cancers. Eighty percent of Cancer of the Head and neck should be treated Treating cancers with drugs radiotherapy to the mouth (with or head - neck cancers are linked to tobacco use. by a multidisciplinary team. The team should No evidence was identified to support the use without adjuvant chemotherapy) should Avoidance of risk factors, screening and early include: of chemotherapy alone as a curative have post-treatment dental rehabilitation. intervention, and rehabilitation can improve survival 1. Specialist head - Neck cancer surgeon. treatment for cancer of the head and neck. and quality of life of head - neck cancer patient. 4 Patients should access lifelong dental

22 Health Health 23 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Preserve the power of self healing..!! Cord blood banking and beyond Why Should Parents Consider Cord Blood still struggling to evaluate an appropriate dosage and Banking? related data for treating such diseases. Preserving the Opting for cord blood banking services enhances the cord blood and tissues assures the availability of probability of future treatments where stem cells can enough undifferentiated stem cells for all the future play a significant role. Unless contraindicated due to applications that research brings to clinical practice. specific clinical condition of one or both the parents, Dr. Ashish Munjal cord blood banking should always be considered. General Manager Further, cord blood banking is especially Cryobanks International India recommended for children whose parents are from [email protected] mixed ethnical background. This is because it is usually difficult to find a potential suitable donor in case the In recent times, the concept of stem cell banking has progenitor cells) and a number of other resident cells child gets sick and needs transfusion. Cord blood of largely picked up in the country. Expecting parents including VSELs (Very small embryonic like stem cells, each individual is about 25% similar to siblings; who have learned about the concept of cord blood EPCs (Endothelial progenitor cells) small quantities of therefore it is also very helpful for multiple births since preservation, have started opting for this once in a life MSCs (Mesenchymal stem cells), etc. All these cells it can potentially save a life in case of fatal disease. time opportunity to ensure healthy future and together form the building block of Haematopoietic Additionally, it should be considered by parents with protection from different diseases for their children system (blood & immunity forming cells), and are family history of severe anemia, cancers, immune and entire family. extremely useful in treating different types of disorders, diabetes and heart disease. With There have been enough instances where cord blood leukemias, lymphomas and blood related disorders advancement in technology, we are now able to stem cells have been used as a part of the treatment like thalassemia and a variety of other diseases. culture cells in the laboratory using Explant method and that has made it possible to store millions of cells and has delivered favorable results. What is WHARTON’S Jelly in stem cell banking? What diseases can be treated with stem cells? for consumption in advance if the need arises in case of The soft gelatinous matrix of umbilical cord is any medical urgencies where stem cells can play Among all the sources of stem cells available for clinical medically termed as Wharton’s jelly. This is also usually substantial role in the treatment. utilization under the ethical guidelines, cord blood and discarded as a medical waste after delivery, but is cord tissue derived stem cells reveal the maximum Why it is advised to store both - Cord blood and found to have multitude of cells with extremely high advantage and remain highly promising in delivering concentrations of stem cells and remarkable Cord tissue? the providential results for various diseased What is Cord blood? regenerative potential. These cells are termed With ever evolving possibilities in regenerative conditions. Apart from use as the proven treatment for Cord blood is the residual blood retrieved from the Mesenchymal stem cells (MSCs) and are found with medicine and with more and more successful clinical blood disorders, these cells have been found highly Umbilical cord which is otherwise disposed off as a many other resident cells that further enhance its trials of stem cells, the time is not too far when such promising for heart related ailments, diabetes, medical waste after delivery. Science has proved time therapeutic benefits. therapies will be practiced routinly. Further, among all autoimmune disorders, ischemic leg ulcers, spinal cord and again that the cord blood and tissue is among the the available sources of stem cells, the cord blood and injury, stroke, developmental pediatric disorders, bone most precious source of highly undifferentiated stem tissue stem cells are still considered the best available defects, osteoarthritis, etc. The ongoing research in cells that have huge regenerative potential and can be resource because of their higher primitiveness, multi- the field of regenerative medicine and cellular used in treatments of many diseases for which there is potent characteristics, less HLA representation, and therapies is expected to bring remarkable outcome for no standard cure in current medical practice. Cord immunomodulatory & immunosuppressant effects. treatment of human suffering from many such blood therapy for varied blood related disorders has Further to its confirmed clinical value, researchers are diseases. now become a routine treatment at many institutes in the country. What are the different types of stem cells in For more details and value added services, Umbilical cord blood? please visit the last page of this magazine The most common stem cells include HSCs (Haematopoietic stem cells), HPCs (Haematopoietic

24 Health Health 25 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Agada - Joslin Fungus Preventive Health in the 10% Discount for Assessment Star Insurance Card Holders CAUSE FORSinus CONCERN? Agada Prevention is better than cure. Star Insurance is very keen in the prevention of Lifestyle illness in their clients. Hence we are happy to offer YOU - our client at unique A Comprehensive DR V RAMASUBRAMANIAN Preventive Healthcare Preventive Health Assessment Programmes “Consultant Internal Medicine - Apollo Hospital” Programmes in collaboration with Agada Hospitals. Director Boosters Adult vaccination Clinic Agada Hospitals is a world-class center Detect - Prevent - Protect Special Programmes and Clinics: established recently in partnership with the ungi are freely found in our environment, the body and cause disseminated infection. At Master Health Check Ups Joslin Diabetes Centre, Harvard Medical from the air we breathe to the soil we times, prolonged use of broad spectrum Women’s Health Clinic Senior Citizen Programme School, Boston USA. F walk on. But when they invade the antibiotics can cause overgrowth of fungi which Diabetes Prevention Programme . human body they can cause are generally not affected by antibiotics. This Protect Heart Programme Protect kidney Programme Master Health Checkups & Package Rates serious problems. But do fungi may cause local fungal infections or at Lipid Clinic Special Programmes inside the human body always times systemic infections like candida in Hypertension Clinic Thyroid & Endocrine Clinic Adult Health Checkup (age: 19-35 years) Rs. 2608/- cause problems? the blood. Obesity Clinic Fitness Clinic Male Peak of Life Checkup (age: 36-55 years) Rs. 3840/- You will be surprised to know But when we culture fungus from Smoking Cessation Program that the human skin, nails and the sinus, is it cause for alarm? Stress Management Program Male Senior Citizens Checkup (age: >56 years) Rs. 6424/- the gastro-intestinal tract can Female Peak of Life Checkup (age: 31-55 years) Rs. 5024/- Fungus like Aspergillus can be carried normally be home to many Female Senior Citizen Checkup (age: >56 years) Rs. 3864/- as spores through the air or can types of fungi. Fungi can be Adolescent Health Checkup (age: 13-18 years) Rs. 2520/- sometimes contaminate beedis and be broadly divided into yeasts or inhaled into the respiratory tract. The Child Health Checkup (age: <12 years) Rs 1300/- moulds. Candida, the predominant fungi can reach the nose and enter the Agada – Joslin Vascular Risk Assessment Rs. 5250/- yeast, normally grows in warm, sinus where they can present as Diabetes Annual Care Plan Rs. 5200/- moist areas like the female genital tract or the human gastro-intestinal 4 Fungal balls – The fungus is found as Diabetes Prevention Programme Rs. 1800/- For Details Call: tract. The moulds, typified by the fungus on a ball which just lies in the cavity Protect Heart Programme Rs. 4600/- decaying bread are generally carried as spores in without causing any problem. The 044-3013 3721 Smoking Cessation Programme Rs. 4000/- the air and can be seen in the respiratory tract. In biopsy shows no spread of the Weight Management Programme Rs. 9500/- people with a normal immune system, the fungi fungus across the lining of the sinus No. 8, Dr. Nair Road, T. Nagar, cavity. If such a ball is removed during Chennai - 600 017. Stress management programme Rs. 3300/- are harmless and can only be a colonizer or cause localized infection. But when the immune a surgical procedure, it does not warrant any treatment. Poor air Based on the programme the checkup will include: physician consultation, lab and imaging work up, fitness assessment, diet counseling, system of the person is weakened by severe Joslin education , foot assessment, eye exam and vascular stiffness assessment. infections, immune-suppressive drugs, immune quality in the buildings can also cause deficiency diseases or cancer, fungus can invade such an infection.

26 Health Health 27 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 4 Allergic fungal sinusitis – Sometimes the condition which can spread insidiously over fungal which enters the sinus can elicit an several months without any major symptoms. allergic response. This may cause symptoms Treatment involves surgically removing the in the form of chronic nasal discharge, tissue as much as possible and follow it up headaches, nasal irritation, cough and thick with antifungal medication for several secretions. If a nasal sinus examination months. shows features of n allergic fungal Correct treatment of fungi in the sinus requires a involvement, the person often responds to look into the sinus and a biopsy with a preferable Discharging oral steroid medication with or without culture of the tissue to determine the exact nature antifungal therapy. This has a tendency to of the fungus and also to determine if it is actually recur. causing an invasion or is only lying around. As 4 Invasive fungal sinusitis – This refers to an Robert Koch said in the nineteenth century “The infection by fungi which can invade the sinus germ is not important; it is the terrain on which it is tissue and can sometimes extend into the found that is important”. A correct understanding EAR eye or the brain. This is a serious of the pathogenesis of the condition can lead to a better treatment. Dr. SENTHIL VADIVU D.N.B., D.L.O., Madras ENT Research Foundation (MERF), Chennai

MADRAS ENT RESEARCH FOUNDATION MANAGEMENT OF A DISCHARGING EAR

ar discharge is m a n a g e d w i t h o n e o f t h e antibiotics. Acute otitis media E c o m m o n e s t In case of acute complaints but it suppurative otitis may also be a complaint media patient will of a serious underlying have sudden onset disease. ear pain, blocked Ear discharge is the usual feeling with fever and symptom of disease of h/o recurrent upper middle ear which is called respiratory infection. “otitis media”. It may be either acute or chronic Complications and sequelae depending upon the duration of the disease (> 3 months is chronic). The infectious and noninfectious complications of otitis media in childhood may result in serious ACUTE SUPPURATIVE OTITIS MEDIA morbidity. Later in life, the infectious (ASOM) complications, include the spread of infection to Acute Otitis media is the most common disease the surrounding bone up to skull base and brain. of childhood, with the exception of viral upper The non infectious sequelae, including respiratory infections. Acute bacterial infection chronic perforation of the ear drum and occurs in 80% of children between the ages of 1 damage to small bones of middle ear leading and 6 years, and it is the disease most frequently

28 Health Health 29 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. to hearing loss. Damage to inner ear leads to is a dangerous infection eroding middle ear c. Cleaning with ear buds. permanent hearing loss and balance disorder. bones and sometimes eroding and spreading d. Applying ear drops without consulting upwards to the brain. OTITIS MEDIA WITH EFFUSION (OME) ENT specialist. The main line of treatment for this condition is e. Nose blowing. Eustachian tube is the tube connecting the surgery. middle ear and nasopharynx. TUMOUR Goals of Surgery One of the main functions of the eustachian Ear discharge may also be a symptom of tube is ventilation. Opening of the eustachian Establish an intact ear drum. underlying cancer. In that case it may be blood tube allows exchanging of gases and Eradicate middle ear disease and create an air- stained with associated symptoms depending equalization between the environment and containing middle ear space. upon the spread. For cancers radical surgical middle ear. If it is affected there will be Restore hearing by building a secure connection management is necessary. collection of serous fluid in the middle ear between the ear drum and the inner ear. Most of the middle ear diseases are curable which is called as otitis media with effusion. Complications and sequelae without complications and sequelae if Causes appropriate treatment is initiated at the right time. Infection spreading to adjacent bones and brain. 1. Acute otitis media (AOM) result in Permanent hearing loss and other damage due persistent otitis media with effusion Nerve deafness. to middle ear diseases can be prevented. (OME). Indirect sequelae include auditory deprivation FAQ IN EAR DISCHARGE Sequelae 2. Eustachian tube dysfunction and block by and language delays. 1. Shall we use buds to clean discharge – enlarged adenoids or cancer. Otitis media may result in auditory deprivation EXTERNAL EAR NO. during early childhood. Middle ear atelectasis In case of middle ear effusion patient will have 2. How to clean wax – Leave it if it is scanty, which is the inward collapse of the ear drum is The bacterial and fungal infection of the external h/o frequent upper respiratory infection & if it is blocking the ear – consult ENT thought to result mainly from longstanding ear also causes ear discharge. There will be mouth breathing and h/o frequent sore throat / severe pain associated. It is treated with Specialist. tonsillitis / fever. It is one of the leading cause of eustachian tube dysfunction. There may be scar appropriate medications. 3. How to prevent water entering infected ear childhood hearing loss. formation over the ear drum which may result in long term hearing loss. TRAUMA while taking bath – use a cotton to plug the Initially medical management with nasal ear which is soaked in coconut oil / In case of recurrent OME we have to look for decongestants and nasal spray are started and vaseline. inspite of that if the effusion persists it is 1. Adenoid hypertrophy surgically drained. 2. Tonsillar infection 3. Sinusitis 4. Dental caries 5. Any other causes of Eustachian tube Trauma to ear may be obstruction BLUNT INJURY CHRONIC SUPPURATIVE OTITIS MEDIA PENETRATING INJURY (CSOM) BAROTRAUMA In case of trauma the discharge will be blood stained associated with ear pain and ear block. In case of trivial injury no intervention is needed but in case of serious injury drainage of hemotympanum is necessary. In case of trauma AVOID In case of CSOM patient will have ear discharge with hearing loss, the ear discharge will be scanty a. Water getting into ear . and foul smelling in case of cholesteatoma which b. Pouring oil into ear.

30 Health Health 31 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 4 Chronic, which lasts more than 12 weeks Also, cases of acute and chronic sinusitis are and can continue for months or even usually accompanied by a stuffy nose, as well as years. by a general feeling of fullness over the entire 4 Recurrent, with several attacks within a face. year. Less common symptoms of sinusitis (acute or What are the Symptoms of Sinusitis? chronic) can include the following: Sinusitis One of the most common symptoms of any type 4 Tiredness of sinusitis is pain, and the location depends on 4 Decreased sense of smell which sinus is affected. 4 Cough that may be worse at night current concepts 4 If you have pain in your forehead, the 4 Sore throat problem lies in your frontal sinuses. 4 Bad breath 4 Pain in your upper jaw and teeth, with tender cheeks, may mean your maxillary 4 Fever sinuses are involved. Because your nose can get stuffy or congested 4 Experiencing pain between your eyes, when you have a condition like the common cold, Dr. ASHISH ALAPPAT sometimes with swelling of the eyelids you may confuse simple nasal congestion with sinusitis. A cold usually lasts about 7 to 14 days M.B.B.S., (DNB) and tissues around your eyes, and and goes away without treatment. Acute sinusitis Madras ENT Research Foundation (MERF), Chennai tenderness when you touch the sides of your nose may mean sinusitis has often lasts longer and typically causes more developed in your ethmoid sinuses. symptoms than a cold. inusitis affects 35 – 45% of Indian produced in the sinus flows out through openings What Causes Sinusitis? population each year, making it one of of the sinuses into the nose. When these 4 Deep achiness at the top of your head, ear S the most common health problems in openings become blocked due to various pain could be a sign that your sphenoid Sinusitis can occur from one of these conditions: sinuses are involved (though these the society. It is common in all age groups reasons, stasis of mucus occurs in the sinuses 4 Colds and allergies may cause too much sinuses are affected less often). with a higher predilection in females. It is more leading to secondary infections with bacteria, mucus to be made or block the opening of prevalent than heart disease and asthma and virus and fungus. There are several types of In addition to the pain, people who have sinusitis the sinuses. has a greater impact on quality of life than chronic sinusitis. (acute or chronic) often have thick nasal 4 Small hairs (cilia) in the sinuses, which back pain or congestive heart failure. secretions that can be white, yellowish, greenish, help move mucus out, do not work Management of sinusitis has been evolving over or blood-tinged. Sometimes these secretions properly due to some medical conditions, the past many years. drain in the back of the throat and are difficult to leads to stasis of mucus in sinus. What do you mean by sinus? clear. This is referred to as “post-nasal drip”. Sinus is an air filled space within the bones of the face. There are 8 sinuses (4 on each side) which contain air and they communicate with the nasal cavity. They are lined with mucinus cells that make mucus to humidify the air and keep the nose from drying out during breathing and to trap unwanted materials so that they do not reach the lungs. When people say, "My sinuses are killing me", they usually are referring to symptoms of congestion and achiness in one or more of the four pairs of cavities. What is Sinusitis? 4 Acute, which lasts up to 4 weeks. "Sinusitis" simply means your sinuses are inflamed-red and swollen. Usually mucus 4 Subacute, which lasts 4 to 12 weeks.

32 Health Health 33 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 4 A deviated nasal septum, nasal bone If your sinuses stop draining properly, the 4 Asthma and allergies. examination of your nose and face can clinch the spur, or nasal polyps may block the bacteria can begin to multiply in your sinuses, 4 Recurrent acute sinusitis. diagnosis. But if your symptoms do not clearly opening of the sinuses. causing acute sinusitis. indicate that you have sinusitis or if they persist The collected mucus thickens because it loses its Allergies and other chronic conditions 4 Pre-existing health conditions. for a long time and do not get better with treatment, you may require a CT (computerized water content as it stays trapped inside the People who have allergies or other chronic Asthma and allergies sinuses for a long time. In addition, inflammation tomography) scan (a form of X-ray that shows problems that affect the nose also are prone to Chronic rhinosinusitis often occurs in people who leads to extra materials being secreted into the some soft-tissue and other structures that cannot episodes of acute sinusitis. Chronic nasal have asthma, many of whom also have allergies. It mucus, causing thickening leading to further be seen in conventional X-rays) to confirm that problems cause the mucous membranes to swell is possible that constant exposure to airborne stasis of mucus and further growth of you have sinusitis. and the sinus passages to become blocked. The allergens (substances that causes an allergic microorganisms. normally harmless bacteria in your nose and reaction) from house dust mites, pets, mold, and Other laboratory tests include the following: Acute Sinusitis throat again lead to acute sinusitis. cockroaches causes chronic inflammation of the 4 Diagnostic nasal endoscopy – to view Acute sinusitis can be caused by the Pre-existing health conditions lining of the nose and the sinuses. An allergic inside your nose and nasopharynx (back following: reaction to certain fungi causes some cases of of nose). In general, people who have chronic rhinosinusitis: this condition is called 4 Common cold. reduced immune function, allergic fungal sinusitis. 4 Allergy test – to test what all you are such as those with primary allergic to. 4 Allergies and other Recurrent acute sinusitis chronic conditions. immune deficiency disease 4 Blood tests to rule out conditions, such as (a defect in the way the If you suffer from frequent episodes of acute an immune deficiency disorder or cystic 4 Pre-existing health immune system responds to sinusitis, you may be prone to developing chronic fibrosis, that are associated with sinusitis. conditions. infection) or HIV infection, are rhinosinusitis. It may be caused by an 4 Absolute eosinophil count. Common cold more likely to suffer from exaggerated immune response to fungi that sinusitis. People who have normally are found in the sinuses or to the How Is Sinusitis Treated? Most cases of acute abnormal mucus secretion or bacterium Staphylococcus aureus, which sinusitis start with a common cold, Acute sinusitis mucus movement, such commonly lives inside the nose. which is caused by a virus. Colds can as those with cystic If you have acute sinusitis, the following may be inflame your sinuses and cause Help Pre-existing health conditions fibrosis (an inherited recommended: symptoms of sinusitis. Both the cold and disease in which thick and As with acute sinusitis, other causes of chronic the sinus inflammation usually go away 4 Antibiotics to control a bacterial infection, sticky mucus clogs the lungs, rhinosinusitis may be an immune deficiency within two weeks. If the inflammation if present. causing breathing problems and disorder or cystic fibrosis. produced by the cold leads to infection 4 Pain relievers to reduce any pain. making it easier for bacteria to grow), caused by bacteria, then this How is Sinusitis Diagnosed? also are more likely to suffer from 4 Decongestants (medicines that shrink the infection becomes acute A good history of your symptoms and sinusitis. swollen membranes in the nose and make sinusitis. it easier to breathe). Chronic Sinusitis The inflammation caused by 4 Antiallergic medications that may include the cold results in swelling of In chronic sinusitis, the nasal steroid spray and anti histamines. the mucous membranes of membranes of both the sinuses your sinuses, trapping air and and the nose thicken because they It should be used as prescribed by the doctor, as mucus behind the narrowed sinus are constantly inflamed. This condition longer term use can lead to even more openings. When mucus stays inside your may be distinguished as either rhinosinusitis with congestion and swelling of your nasal passages sinuses and is unable to drain into your nose, it or rhinosinusitis without nasal polyps. and other health problems. can become the source of nutrients for bacteria, Nasal polyps are grape-like growths of the Chronic rhinosinusitis which can then multiply. mucous membrane that protrude into the sinuses Two options are available ie, medical or surgical. Most healthy people have bacteria, such as or nasal passages, making it even more difficult A trial of medicines is given first and if symptoms Streptococcus pneumoniae and Haemophilus for the sinuses to drain and for air to pass through are not relieved surgery may be considered influenzae, in their noses and throats. Usually, the nose. The causes of chronic rhinosinusitis Medicine these bacteria cause no problems, but when you are largely unknown, but there are some sniff or blow your nose when you have a cold, conditions that may put you at higher risk for 4 Nasal steroid sprays, Anti histamines and these actions create pressure changes that can developing it, including the following: Anti leukotriens. send typically harmless bacteria into the sinuses.

34 Health Health 35 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 4 Saline nasal sprays can be helpful in endoscopic assistance and fluoroscopic C-arm chronic rhinosinusitis because they guidance. Endoscopic sinus surgery (with remove thick secretions and allow the balloon sinuplasty technology) utilizes a small, sinuses to drain. flexible, sinus balloon that is placed into the nose 4 Oral steroids, such as prednisone, may be to reach the sinuses. The sinus balloon is then p r e s c r i b e d f o r s e v e r e c h r o n i c gradually inflated to gently restructure the & previously blocked sinus opening which helps to Swallowing rhinosinusitis. restore normal sinus drainage and function. The Surgery main advantage of this surgical technique over Reflux Disorders Nasal surgery does not involve any external the conventional endoscopic sinus surgery is the incision or scar preservation of the normal anatomy of the most vital area of the nose called the osteo-meatal Functional Endoscopic Sinus Surgery (FESS) complex. This surgery removes anatomical and WHAT PRECAUTIONS SHOULD I TAKE? pathological obstructions associated with sinusitis in order to restore normal clearance of 4 Maximum avoidance of exposure to the sinuses. substances which you are allergic. Dr. S. SUDHA MAHESHWARI 4 Enlarge the natural openings of the 4 Keep your home and work environment M.B.B.S., D.N.B., sinuses. clean. Madras ENT Research Foundation (MERF), Chennai 4 Remove nasal polyps. 4 Avoid very dry and dusty environments, use air purifiers and humidifiers if 4 Correct significant structural problems necessary. eople normally swallow hundreds of also result from dysphagia. inside the nose and the sinuses if they times a day, to eat solids or drink liquids, 4 Avoid exposure to irritants such as Evaluation and management of swallowing contribute to sinus obstruction. P and swallow the normal saliva and cigarette and cigar smoke or strong odors disorders requires a multidisciplinary team Balloon sinuplasty mucous which the body produces. An from chemicals. approach. When dysphagia is persistent and the The balloon sinuplasty operation involves the interruption in the swallowing process can cause cause is not apparent, the otolaryngologist 4 Avoid long periods of swimming in pools use of an FDA approved Balloon Sinus difficulties. Difficulty in swallowing is termed as (ENT)-head and neck surgeon will discuss the treated with chlorine. Dilatational System, which is used to widen the Dysphagia. One of the most common causes of history of the problem and examine the mouth natural opening of the paranasal sinuses with 4 Avoid water diving, which forces water dysphagia is gastroesophageal reflux. This and throat. This may be done with the aid of into the sinuses from the nasal passages. occurs when stomach acid moves up the mirrors or a small tube (flexible laryngoscope) esophagus (food pipe) to the pharynx (throat), 4 Avoid air travel during an acute sinusitis. which provides vision of the back of the tongue, causing discomfort. Other causes may include: throat, and larynx (voice box). If necessary, an DOES PRANAYAMA HELP? stroke, progressive neurologic disorder, the examination of the esophagus, stomach, and Pranayama or Deep breathing exercise have presence of a tracheostomy tube, a paralyzed upper small intestine may be carried out by the proved efficacious in controlling sinusitis as it vocal cord, a tumor in the mouth, throat or otolaryngologist or a gastroenterologist. These increases the Nitric oxide content of inspired air esophagus, or surgery in the head, neck or specialists may recommend X-rays of the which help in better lung functioning and also esophageal areas. swallowing mechanism, called barium swallow help to clear the mucus at a faster rate from the Symptoms of swallowing disorders may include which is done by a radiologist. sinus. drooling of saliva, a feeling that food or liquid is If special problems exist, a speech pathologist sticking in the throat during or after a meal or may consult with the radiologist regarding a while swallowing saliva, discomfort in the throat modified barium swallow or videofluoroscopy. or chest, a sensation of a foreign body or "lump" These help to identify all four stages of the in the throat. Weight loss and inadequate swallowing process. Using different nutrition due to prolonged or more significant consistencies of food and liquid, and having the problems with swallowing, coughing or choking patient swallow in various positions; a speech caused by food, liquid or saliva not passing easily pathologist will test the ability to swallow. An during swallowing, and small amounts of food, exam by a neurologist may be necessary if the liquid or saliva being sucked into the lungs could

36 Health Health 37 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. which trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully. Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual TINNITUS and whether supplements are necessary. Surgery is used to treat certain problems. If a MANAGEMENT narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it swallowing disorder stems from the nervous may need to be dilated or even released system, perhaps due to stroke or other surgically. This procedure is called a myotomy. neurologic disorders. Many causes contribute to swallowing disorders. Dr. John. K. Thomas If you have a persistent swallowing problem, D.L.O., (DNB) Once the cause is determined, swallowing consult an otolaryngologist-head and neck disorders may be treated with: Madras ENT Research surgeon. Foundation (MERF), Chennai 1. Medications 2. Swallowing therapy 3. Surgery Treatment is tailored to the particular cause of the swallowing disorder. Many of these disorders can be treated with medications. Drugs that slow stomach acid production, muscle relaxants, and Tinnitus means to antacids are a few of the many medicines 'jingle' or 'ring like a bell'. available. Gastroesophageal reflux can often be treated by t is the perception of a noise in the ears Subjective tinnitus: It is much less understood, changing eating and living habits - for example: or head in the absence of external with the causes being many and open to debate. 4 Eat a bland diet with smaller, more I sounds, frequently described as Anything from the ear canal to the brain may be frequent meals. ringing, buzzing, humming, hissing etc. involved. 4 Eliminate alcohol and caffeine reduce Some may have tinnitus in one ear or both and What does tinnitus sound like? weight and stress. some describe it as coming from inside the brain. Tinnitus can be high pitched or low pitched and Tinnitus sounds like the high-pitched background 4 Avoid food within three hours of bedtime. can be constant or come and go intermittently. squeal emitted by some computer monitors or 4 Elevate the head of the bed at night. television sets, noises like hissing steam, rushing Tinnitus is of two types: water, chirping crickets, bells, breaking glass, or If these don't help, antacids between meals and Objective tinnitus: This consists of head noises even chainsaws. Some report that their tinnitus at bedtime may provide relief. audible to other people in addition to the sufferer. temporarily spikes in volume with sudden head Many swallowing disorders may be helped by The noises are usually caused by vascular motions during aerobic exercise, or with each direct swallowing therapy. A speech pathologist anomalies, repetitive muscle contractions, or footfall while jogging. Objective tinnitus sufferers can provide special exercises for coordinating inner ear structural defects. may hear a rhythmic rushing noise caused by the swallowing muscles or restimulate the nerves

38 Health Health 39 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. their own pulse. This form is known as pulsatile Tinnitus along with giddiness and hearing from either a single exposure or cumulative 4 Amplification: Hearing aids can reduce tinnitus. impairment or fullness of the ear is seen. A proper trauma. There are "tough" ears, and there are or even eliminate some forms of tinnitus. If What causes tinnitus? evaluation of the patient can aid in the timely "weak" ears; what may be safe or dangerous for a patient has a hearing loss and the treatment and cure of this common malady. one individual may not be the same for you. If you tinnitus is in the medium or low pitches, Ototoxic drugs ever experience temporary ringing after a sound often a hearing aid will provide relief. The exposure, you are at a severe risk for tinnitus hearing aid renders the patient capable of Many prescription and over-the-counter drugs and/or hearing loss. hearing ambient environmental noises may cause tinnitus that may be permanent or instead of the tinnitus. may disappear when the dosage is reduced or eliminated. Before starting treatment with any 4 Tinnitus masking units: These devices prescription drug, tinnitus sufferers should resemble hearing aids and present a always ask their physician and / or pharmacist selected band of noise to the patient's about the potential for ototoxic side effects. ears. This external “shh” sound is often These drugs include: immediately perceived as a more pleasant sound than the internal tinnitus salicylate analgesics (higher doses of sound. A “tinnitus instrument” is a unit aspirin) that combines both a masker and a Overexposure to loud noises ibuprofen hearing aid. Bedside sound devices, Repeated exposure to loud noises such as guns, audio tapes and even FM-radio static can other non-steroidal anti-inflammatories artillery, aircraft, lawn mowers, movie theaters, produce a masking effect. Some patient's amplified music, heavy construction, etc, can aminoglycoside antibiotics experience “residual inhibition” – the cause permanent hearing damage. Some people anti-depressants reduction or elimination of tinnitus – after report auditory fatigue from driving automobiles the masking noise is removed. The period loop-inhibiting diuretics long distances with the windows down. Anybody What treatments are available for Tinnitus? of residual inhibition is usually very short, quinine/anti-malarials regularly exposed to these conditions should Several forms of treatment are currently often less than one minute. consider wearing ear plugs or other hearing oral contraceptives available and several other experimental 4 Tinnitus Retraining Therapy (TRT): protection. chemotherapy approaches hold promise for the future. These TRT is a treatment program designed to Wax in the ear canal include: retrain the brain so that “habituation” to Vascular abnormalities If you're experiencing tinnitus, this is one of the tinnitus can occur. TRT combines first things you should check for. NEVER try Arteries may press too closely against the inner directive counseling and sound therapy digging or suctioning the ear canal yourself as ear. This is sometimes correctable by delicate by having the patient wear sound SERIOUS damage may result. Numerous micro ear surgery. generators that emit a stable, low-level over-the-counter ear wax solvets are available Temporo-Mandibular Joint (TMJ) syndrome broad-band noise. 80% of those from your drugstore which will clean the ear canal undergoing TRT experience success This jaw disorder may cause tinnitus and is within 18-24 months. in a safe and gentle manner. characterized by many symptoms, including Excessive mobile phone usage headaches, earaches, tenderness of the jaw 4 Drug therapy: Many drugs have been investigated as possible relief agents for Tinnitus, a warm sensation in the ear muscles, dull facial pain, jaw noises, the jaw locking open, and pain while chewing. tinnitus. They include anti-convulsants, or a high frequency hearing loss are tranquilizers, anti-anxiety medications, the early warning signs that it is How can I avoid getting tinnitus? vasodilators, and antihistamines. These essential to reduce the duration of The number one cause of tinnitus is exposure to drugs have helped some patients mobile phone use and excessively loud noise. Either avoid these noisy effectively manage their tinnitus. Severe ear infections situations, or wear hearing protection. Wedding 4 Bio feedback: This is a relaxation Tinnitus occurs after severe ear infections. But halls, political meets, movie theaters, nightclubs, process in which one learns to control his this may also be related to the use of ototoxic construction sites, guns, power tools, stereo or her physiological reaction to stress. antibiotics. headphones, rock concerts, and musical Since stress seems to aggravate tinnitus, instruments are just some of the things that can control over one's reaction to stress often Meniere's Disease be hazardous to your ears. Damage can result Fig.3: Hearing Aid

40 Health Health 41 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. helps minimize the tinnitus. have reported worsening of their tinnitus 4 Cochlear implants: These surgically with this therapy. implanted devices are designed for 4 Neuromonics Tinnitus Treatment: This people with little or no usable hearing. treatment utilizes a small, lightweight t Against Some of these patients report post device with headphones that delivers Figh Vertigo Cold operative improvement in their tinnitus. precise music embedded with a pleasant Headachy Research is ongoing to determine if a type acoustic stimulus. These sounds, Dizzy of implanted stimulus can be devised for customized for each user's audiological & people with tinnitus and normal hearing. profile, stimulate the auditory pathway to 4 Dental treatment: Persons with promote neural plastic changes. Over Hungry temporomandibular joint (TMJ) problems time, these new connections help the Shaky associated with tinnitus can be treated brain to filter out tinnitus disturbance, with effective relief provided for some who providing long-term relief from symptoms. Confused suffer from this dual problem. Symptoms Some may report relief from this of damage to this joint (located just below treatment immediately but most will the ear) include tinnitus, jaw-clicking and experience relief within a 6 month period ear pain. of time. Sweaty Grumpy 4 Counseling: Therapies such as cognitive As the age old adage goes “Prevention is therapy, behavioral modeling, patient better than cure”, conditions leading to education and support groups have Tinnitus is better avoided and timely consultation with an otologist can help in proven useful for many patients who are S. NIRANJANI making proper and informed choices. struggling with tinnitus. Physiotherapist & 4 E l e c t r i c a l s t i m u l a t i o n : T h i s Fitness Fitness Consultant experimental therapy involves electrical energy transmitted to the cochlea via Section electrodes placed near the ears. While a degree of success has been noted, some Vertigo is a particular form of dizziness were one feels as though they or their surroundings, are spinning when in fact they are not so. Vertigo is most often caused by inner ear damage which is one of the source of information about balance .It detects the direction of gravity. There are two types of vertigo, vertigo relating to central nervous system is known as central vertigo and vertigo due to problem in inner ear is known as peripheral vertigo. Apart from medication to treat vertigo there are various rehabilitation exercises to overcome vertigo in your day to day activities. Few are Canal repositioning maneuver, Cawthome Cooksey head and eye exercises, Brandt – Daroff exercises, Epley maneuver and balance retraining. Few of the mentioned exercises are done with the help of a doctor.

One of the most common exercises which are Step 1: taught by the physiotherapist to the patient with Sit at the edge of the bed in such a way that Fig.4: External and Internal Component of a Cochlear Implant peripheral vertigo is Brandt – Daroff exercises. you have enough space to lie down on both the sides The procedures are as follows

42 Health Health 43 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. The above cycle is one repetition .The below hydrated drink lots of water, maintain your diet mentioned exercises has to be performed in and of course have proper sleep. sitting position A recent study sponsored by the American EYE EXERCISES College of Sports Medicine indicated that 1. Look up and down. exercising moderately while you have a common cold doesn't affect the severity or duration of the 2. Start slowly and gradually increase your speed. symptoms or compromise the immune system. 3. Look from side to side, start slowly and then But high intensity exercise such as heavy weight gradually increase the speed. lifting or high intensity aerobic training has been shown to have a negative impact on the immune 4. Point your finger at arm's length, focus on it and system during a cold or any respiratory infection. move the arm slowly towards you and out again. Certain things has to be kept in mind when you go HEAD EXERCISES to gym with cold. 1. Start with eyes open, bend your head forward Step 2: Step 5: *Always carry a hand towel with you and make and then backward, slowly and gradually From the sitting position lie down onto your side Return to the sitting position and if sure to keep your sweat to yourself. symptoms persist stay for 30 seconds increase your speed. *Make sure the equipment is wiped with 2. With your eyes open turn your head from one disinfectant after use. side to other, start slowly and gradually increase your speed. *Avoid touching your hands to your mouth, nose, or eyes while at the gym. 3. Once the symptoms decreases do the same with your eyes closed. *Carry your sipper instead of drinking the water which is provided at the gym. The above said exercises has to be performed in the presence of physiotherapist. As exercises *Avoid going to steam and sauna, chances of varies from patient to patient the above described spreading the infection to others is more. exercises are just a few, consult your doctor and * Excessive exercise is very detrimental to your physiotherapist and go ahead. Step 3: health, so Sit with your trainer and review your Keep your head at 45degree angle in such a way Apart from exercises their are few safety workout plan as your immune system is down that you are looking at some one standing Step 6: 6' tall in front of you measures which has to be taken care. ,you need to do some light weight training and Now lie down onto your other side and keep moderate amount of cardio. your head at 45 degree angle ,remain in the position *Wear proper footwear, make sure that the soles for next 30 seconds or till the symptoms subsides have good grip. *Make sure that you are not over training. *get your eyes checked on regular basis if you *Staying on treadmill or other cardio machines an are wearing spectacles. extra time to lose those post-holiday weight? These "extra" efforts may be causing you more *Leave a light on in the bathroom and bedroom harm than good. during night. *Cut back the length and frequency of your *Avoid taking alcohol. training sessions if you are feeling sluggish. TRAINING WITH COLD *Reduce caffeine and alcohol intake as it is Can I do my exercises when I have cold or what harmful to the immune system. exercises should I do? As you read on many As you follow the given details you would be able such doughts will be cleared. Their will be to overcome cold easily and can look out for obvious lower strength and endurance when you faster recovery without a break in your routine have cold. If you have symptoms like fever, dry exercises. cough, sore muscles, vomiting and diarrhoea Step 4: Step 7: then exercise are not recommended. It's always Exercise and stay happy! Remain in that position till 30 seconds Return to the sitting position and stay for or the symptoms like dizziness subsides next 30 seconds better to take rest till the infection has gone. Always make sure that you keep yourself

44 Health Health 45 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. 24x7 Expert Medical Consultation Corner Over Phone Jackfruit It has been our motto to ensure preventive care information Seed and assistance for good health and as a back stop provide financial indemnity though insurance cover. To address the magazine and the new initiative is 24x7 free expert medical Patchadi consultation over phone. When do you utilize this service + Whenever you feel like visiting a doctor, say, for a common ailment viz, cold, cough or b o d y p a i n , b e f o r e

y! proceeding, what you have to Jackfruit seed patchadi seems to be yumm do is to call our Toll free number. The Medical personnel will take But how do we prepare it? Let's see the method. the details from you and you will be advised simple preventive Method steps, over the counter medicines or suggest you to go for a medicines or suggest you to go for a medical consultation. Our Pressure cook the jackfruit seeds for 5-10 Toll free number is 1800 425 2255 and it is mentioned in the minutes policy document. Peel the outer skin and chop the seeds Language: The receiver of the call will converse in Tamil, Grind the boiled jack fruit with ginger, green Ingredients 10 nos Hindi, Malayalam and of course in English. We will be chillies and curd thankful to receive in English. We will be thankful to Jackfruit seed 10 nos Add little water, salt to taste receive your communication on any suggestions to Curd 1 cup (200ml) Splutter mustard seeds and curry leaves in make the system better and more effective to the Green chillies 3 nos coconut oil and add to the patchadi editor of this magazine. Ginger chopped 1tsp Serve with plain rice, pulav, paratha, etc Coconut oil 1tsp Benefits Mustard seeds ½ tsp Rich in phytonutrients Curry leaves few springs As the seeds are cooked with the skin, the fibre Asafoetida a pinch content is high Salt to taste To an extent it also helps in indigestion

46 Health Health 47 Pers o n al & Carin g Insurance The Health Insurance Specialist The Health Insurance Specialist Pers o n al & Carin g Insurance

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255. CLAIMS PROCEDURE

At Star Health Insurance, we always interact with customers with a humane and healing touch. We ensure it remains the same when customers need assistance by keeping the claim process simple and easy. We have a 24x7 medical assistance for consultation and facilitation with regard to hospitalization needs. Our aim is to provide cashless hospitalization in a hassle - free and time bound manner. We have entered into arrangements with network hospitals to provide cashless hospitalization, so you don’t have to worry about any advance payments. The steps to avail this benefits are as follows: India’s Highly Accredited Inform the Star Health Call Centre by quoting the Star Identity Card or Policy Number within 2 hours of admission. This is mandatory. Cord Blood Bank Show the Star Identity Card / quote the Policy Number at the hospital reception and request for cashless hospitalization. Ensure that the completed Pre-authorization form and related medical reports are faxed to the Star Health Call Centre by the hospital. This is mandatory. Invest for Life..!! A copy of Pre-authorization form duly filled along with all relevant medical reports (that substantiates the need for hospitalization) should be provided by the Gift your child the hospital to the visiting Star Health Doctor. Power of self-healing On receipt of duly filled Pre-authorization form and based on the feedback from Star Health’s Doctor, appropriate decision will be communicated to the hospital by Ensure a healthy future by us. preserving your baby’s The authorization letter mentioning the amount sanctioned for the treatment will Cord blood stem cells be faxed to the hospital. This helps the policy holder to get treatment without paying any money to the hospital.

Contact us for more details: 1-800-102-2796 (Airtel) I 1-800-180-1217 (BSNL) www.cryobanksindia.com SMS “STAR” to 56677 | www.starhealth.in 1800-425-2255 I www.starhealth.in Toll Free: 1800 425 2255 | Fax Toll Free: 1800 425 5522

Disclaimer: No part of this publication may be produced without the prior permission of the publisher. All care has been taken about factual accuracy in compilation, updation and validation of information. However, the publisher accepts no responsibility for inadvertant errors, if any and their consequences.

Insurance is the subject matter of solicitation.

Cryobanks International India Pvt. Ltd. Head Office : 129 I Pace City -1 I Sector – 37 I Gurgaon – 122001 I Haryana (India) Tel : 0124-4265030-34, 0124-4734100-110 l Helpline No. : 09582284444 [email protected] I www.cryobanksindia.com

48 Health Pers o n al & Carin g Insurance The Health Insurance Specialist

Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.