ASK THE DOC
Nasal allergy and ear infections
Y. Rajesh:
I am 22. I am suffering from sinusitis along with deviated septum and nasal allergy. I have had chronic headaches in the frontal and maxillary sinuses. I have had post-nasal drip also. Due to these headaches I lack concentration and face attention problems. Oral medicines given by ENT specialists did not help. In January, I consulted an ENT surgeon, and he advised ESS after undergoing nasal endoscopies and CT scan of PNS. I underwent ESS but I didn't get any relief after surgery. What should I do?
Answer: In your case, the cause of your headaches may not be of nasal or sinus origin. Allergic mucosal thickening in your maxillary and frontal sinuses might not have been the cause of your headaches. You should go to your surgeon and explain that you have had no relief. If there is no definite E.N.T. cause, other possible causes like neurogenic, vascular or ophthalmic causes should be explored, with detailed history and opinion from the concerned specialists.
G. Jayaraman:
I have been suffering from nasal allergy for several years due to which I have developed polyps on one side of the nasal passage. I also had attacks of asthma recently. An ENT specialist advised me to undergo surgery to remove the polyps. I am 76. Is it advisable to undergo surgery? If not, what is the alternative?
Dr. N. Vishnu Swaroop Reddy, Consultant E.N.T. and Facial Plastic Surgeon, Care Hospitals, Hyderabad, replies:
If you are fit for the general anaesthetic and if you have persistent nasal obstruction, surgery is certainly advisable. If not, polyps can be removed even under local anaesthesia, using microdebrider if available, to improve the nasal airway. Indirectly, removing polyps will help your asthma to. I would send the polyps for biopsy, if they were unilateral (one-sided) considering your age. Usually nasal polyps are bilateral (two-sided). CT Scan of paranasal sinuses is also helpful to exclude neoplastic conditions. Polyps are known to recur, more frequently in asthmatics. If they are small and not causing much trouble you can try corticosteroidal nasal sprays (mometasone, fluticasone or budesonide) or betamethasone nasal drops (not more than 3 months) on E.N.T. Specialist's advice.
Anil Singh Gusain:
I am 21 years old and I am suffering from tinnitus in my left ear while my right ear is perfect. For some time now I have developed dizziness, unconsciousness and drowsiness. There has been vomiting also. My ENT specialist suspected it to be Meniere's Disease and gave me Vertin 16 mg, Wysolone 20 mg, Nasaldrop and Rabicap 20 mg. He has also done my audiometry test. I have mild hearing loss. I am under much stress. Could the problem be due to that? What should I do?
Answer: Unconsciousness and drowsiness are not the features of Meniere's disease. Dizzy spells lasting minutes to hours with nausea or vomiting, tinnitus (ringing noises in the ear), fluctuating sensorineural hearing loss and fullness of the ear are the usual symptoms of the Meniere's disease. Usually these symptoms start in one ear, but can affect both ears in 30 per cent of the cases, one after the other. Hearing loss and noises in the ear can get worse during dizzy spells. Audiogram might show one-sided low tone sensorineural deafness in the early stages. The patient's history is very important to diagnose Meniere's disease. Electrocochleography shows increased negative summating potential. This test is not very handy and may be available in selective centres in our country. Stress can always precipitate an attack of Meniere's disease. Vertin (Betahistine) 16 mg, three times daily is advised long-term. Low salt diet is recommended. But Wysolone should not be taken for long periods, as it is corticosteroid. The other medications advised are cinnarizine and prochlorperazine to be taken, if necessary on doctor's prescription, along with Vertin. If symptoms are not relieved, thiazide diuretic can be given for short periods. If there is no relief from this treatment, surgical procedures have been tried in the past. The current surgical treatment accepted all over the world is intra-tympanic Gentamycin instillation (injecting into the middle ear) on weekly or fortnightly basis, three to six doses, as an outpatient procedure. It has excellent results in relieving dizzy spells. But there is a small risk of worsening of hearing with this procedure. You said that your right ear is perfect and that you have mild hearing loss in the left ear. If you have unequal hearing of more than 20dB in two consecutive frequencies, you should be investigated with MRI Scan of the brain to rule out CP angle lesions (Retro-cochlear pathology).
K.V.N. Shiva:
I am 47 and suffer from Allergic Rhinitis. It used to be under control with antihistamines like cetrizine and neolorodin but is now giving trouble for the last two years with permanent sore throat due to post-nasal drip. There is no problem in larynx. Once I sneeze it is painful and takes some time to swallow without pain. ENT specialist has prescribed Flomist and antihistamines but it does not help. Is there some permanent cure?
Answer: Corticosteroidal nasal sprays and antihistamines are recommended for the allergic rhinitis. But they are not helpful for the sore throat. Identify the cause of the allergy and avoid it. If you have long standing postnasal discharge and allergic rhinitis, it may be worth doing a CT-scan of paranasal sinuses. And also your pharynx should be thoroughly examined, to find out any other cause of sore throats like tonsillitis or pharyngitis.
S. Rajagopalan:
I am a Meniere's disease patient for the last 10 years. I get two types of vertigo: sudden lasting 10-20 seconds, where I feel that I may fall down. This used to be a rare occurrence but has recently become repetitive (once in a week or so). The second type of vertigo, where I feel some symptoms, occurs very often. I get ringing sounds in both the ears very often. I feel the hearing loss gradually in both the ears. I cannot attend to telephone calls with my left ear. I manage conversations and my lectures. I have been taking VERTIN 8 mg.-one tablet at night for the past two or three years and some vitamin tablets on the advice of my ENT Doctor. Please clarify whether wearing a BTE hearing aid will help? I am a lecturer. Will hearing loss make me unfit for the job? Can I travel in plane or go to places like Tirupati because of my vertigo problem? Is complete hearing loss the end of this problem and how it can be tackled?
Answer: It appears that you have bilateral Meniere's disease. You need to have an audiogram to check your hearing levels in both the ears. You will certainly benefit from BTE hearing aid to communicate either at work or at home. The side on which you have to the hearing aid will depend on the audiogram. If your dizzy spells are under control, you can travel. Ideally, you should have Vertin 16 mg three times daily. Based on your audiogram and hearing status, hearing loss can be arrested at current levels. Intra-tympanic Gentamycin can be tried. Your second type of transient dizzy spell lasting few seconds is BPPV (Benign Paroxysmal Positional Vertigo), simply called Positional Vertigo. This condition can be associated with Meniere's disease. It is because of otoconial debris (calcium carbonate deposits) floating in the semicircular canals of the inner ear, usually involving the posterior canal. It can be diagnosed by Hallpike positional test and can be cured by Particle Repositioning techniques (Epley's or Semont's manouvre).
N. Shanmugam:
I am 60. I am taking Aten-25 tablet for BP (Range is between 120/80 and 130/85). Sometimes it falls to (110/70). I have been using hearing aid in my right ear for 15 years. For the two and a half months I have been hearing different sounds at frequent intervals. I have problem in my neck with slight giddiness. I took MRI scan of my neck and spine showed decay of neck bone and the orthopaedician advised me to exercise and to have Methylcobalamine injections. But the ear problem persists. Audiogram reveals significant loss of hearing in my right ear. Left ear hearing is better than right ear, but not normal. An ENT specialist said that the nerves are not much affected, but membranes are weak and so surgery is not advisable. Are these problems related? I was prescribed Bilovas and Mucodyne tablet along with mecobalamine tablet. Immediately after B12 injection the intensity of sound increases. The same effect is there when I take Becosule capsules. What should I do?
Answer: Your neck problem is different from your ears. Neck problem will not affect the ears. Noises in the ear are due to the hearing loss in both the ears. There is no medicationthat can definitely help for the noises (Tinnitus). Intra-venous Xylocaine has been tried with some temporary benefit, but it needs cardio-vascular monitoring during administration. The problem is not serious; try to ignore the noises by listening to music or the radio. If you have difficulty in sleeping, you might need an antidepressant. Hearing aids and tinnitus maskers are helpful for some. Hearing therapy, Tinnitus counseling and Tinnitus Retraining Therapy can be tried. You need to consult a hearing therapist or an experienced audiologist.
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