Pyogenic Granuloma

Pyogenic granulomas are common skin and mucosal growths that are small and usually reddish in color. They tend to bleed because they contain a very large number of blood vessels. They’re also known as lobular capillary hemangiomas.

These growths mainly affect children and young adults, although they can develop in people of all ages. They are also fairly common in pregnant women—the hormone changes that occur during pregnancy can cause these growths to develop.

The aetiology is not fully understood: rapid growth occurs in response to an unknown stimulus that triggers endothelial proliferation and angiogenesis.

• Trauma and burns can provoke the sequence but frequently there is no identifiable cause.
• Other suggested causes include viral oncogenes, hormonal influences (pregnancy, oral contraceptive pill) and cytogenetic abnormalities.
• They have also been associated with certain medications.

Tips
Consult your doctor if you notice any rapid growth of skin or mucous membranes to the diagnosis. They are prone to easy bleeding, so that the dressing may need to treat the lesion.

Treatment

These lesions bleed easily so often tre
atment is urgently needed to control the hemorrhage. Treatment entails surgical excision under local anesthesia, cryotherapy, electrocautery or laser.

Oral thrush

Oral Candidiasis 

Oral thrush, also called oral candidiasis, is a condition in which the fungus Candida albicans accumulates on the lining of your mouth. Candida is a normal organism in the mouth, but sometimes it can overgrow and cause symptoms.

Oral thrush causes creamy white lesions, usually on the tongue or inner cheeks. Sometimes oral thrush may spread to the roof of the mouth, gums or tonsils, or the back of the throat.

Anyone can develop oral thrush, but the infection is more common in certain people. Risk factors include:

• Being an infant or elderly
• Having a weakened immune system
• Wearing dentures
• Having other health conditions, such as diabetes
• Taking certain medications, such as antibiotics or oral or inhaled corticosteroids
• Undergoing chemotherapy or radiation treatment for cancer
• Having conditions that cause dry mouth
• Smoking

Symptoms

Depending on the underlying cause, signs and symptoms may develop slowly or suddenly, and they may persist for days, weeks or months. 

Signs and symptoms may include:

• Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums and tonsils
• Slightly raised lesions with a cottage cheese-like appearance
• Redness or soreness that may be severe enough to cause difficulty eating or swallowing
• Slight bleeding if the lesions are rubbed or scraped
• Cracking and redness at the corners of your mouth (especially in denture wearers)
• A cottony feeling in your mouth
• Loss of taste

In severe cases, the lesions may spread downward into the esophagus the long. If this occurs, there may be a difficulty in swallowing.

Prevention

These measures may help reduce the risk of developing candida infections:

• Rinse your mouth. If you have to use a corticosteroid inhaler, be sure to rinse your mouth with water or brush your teeth after taking your medication.
• Good oral hygeine. Brush your teeth at least twice a day and floss daily or as often as your dentist recommends.
• Clean your dentures. Clean your dentures daily. Ask your dentist for the best way to clean your type of dentures.
• Regular visits toi the dentist, specially if you have diabetes or wear dentures. 
• Try limiting the amount of sugar- and yeast-containing foods you eat. These may encourage the growth of candida.
• Maintain good blood sugar control if you have diabetes.Well-controlled blood sugar can reduce the amount of sugar in your saliva, discouraging the growth of candida.
• Treat any vaginal yeast infections that develop during pregnancy as soon as possible.
• QUIT SMOKING

Treatment

Adults with weakened immune systems are treated with antifungal medication. But Candida albicans can become resistant to many antifungal medications, especially in people with late-stage HIV infection. So a drug called amphotericin B may be used, but only when other drugs aren't effective, as it can cause serious side effects.

For mild oral thrush, the usual treatment that is tried first is miconazole mouth gel for seven days. Sometimes a two-week course is needed. Nystatin drops are another option if miconazole gel cannot be used

Common cold. The flu

Sniffles, sneezes and perhaps a sore throat and annoying cough, the common cold catches all of us from time to time. The common cold is a self-limited contagious illness that can be caused by a number of different types of viruses. The common cold is medically referred to as a viral upper respiratory tract infection occurring at any time of the year, but most commonly in the winter or rainy season.
Cold symptoms usually start about 2 or 3 days after you came in contact with the virus, although it could take up to a week. Symptoms mostly affect the nose.

The most common cold symptoms are:

• Nasal congestion 
• Runny nose 
• Scratchy throat 
• Sneezing 
• Adults and older children with colds generally have a low fever or no fever.

Depending on which virus caused your cold, you may also have:

• Cough 
• Decreased appetite 
• Headache 
• Muscle aches 
• Postnasal drip 
• Sore throat 
• Symptoms

Because so many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem. In fact, children in preschool and elementary school can have 6 to 12 colds per year while adolescents and adults typically have two to four colds per year.
This occurs mostly during the winter season due to closer contact in closed spaces that don't have the appropriate ventilation.

How is the common cold transmitted?

The common cold is spread either by direct contact with infected secretions from contaminated surfaces or by inhaling the airborne virus after individuals sneeze or cough. Person-to-person transmission often occurs when an individual who has a cold blows or touches their nose and then touches someone or something else. A healthy individual who then makes direct contact with these secretions can subsequently become infected, often after their contaminated hands make contact with their own eyes or nose. A cold virus can live on objects such as pens, books, telephones, computer keyboards, and coffee cups for several hours and can thus be acquired from contact with these objects.

Prevention!!!

• Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. 
• Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children's toys periodically. 
• Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don't have a tissue. That way they cover their mouths without using their hands. 
• Don't share. Don't share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold. 
• Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.

Treatment

The common cold does NOT need antibiotics!!!

You may not be able to cure your common cold, but you can make yourself as comfortable as possible. 

These tips may help: 

1. Drink lots of fluids. Water, juice, clear broth or warm lemon water are all good choices. They help replace fluids lost during mucus production or fever. Avoid alcohol and caffeine, which can cause dehydration, and cigarette smoke, which can aggravate your symptoms.
2. Try chicken soup. Generations of parents have spooned chicken soup into their sick children's mouths. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the movement of neutrophils — immune system cells that help the body's response to inflammation. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the time viruses are in contact with the nasal lining.
3. Get some rest. If possible, stay home from work if you have a fever or a bad cough, or are drowsy after the medications. This will give you a chance to rest as well as reduce the chances that you'll infect others. 
4. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
5. Adjust your room's temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
6. Soothe your throat. A saltwater gargle — 1/4 to 1/2 teaspoon (1.2 milliliters to 2.5 milliliters) salt dissolved in an 8-ounce (237 milliliters) glass of warm water — can temporarily relieve a sore or scratchy throat.
7. Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops, they're effective, safe and nonirritating, even for children. In infants, experts recommend instilling several saline drops into one nostril, then gently suctioning that nostril with a bulb syringe (push the bulb in about 1/4 to 1/2 inch, or about 6 to 12 millimeters). Doing this before feeding your baby can improve your child's ability to nurse or take a bottle, and before bedtime it may improve sleep. Saline nasal sprays may be used in older children.

Otitis media with effusion (glue ear)

Glue ear is a common childhood condition in which the middle ear becomes filled with fluid. The medical term for glue ear is otitis media with effusion (OME).

It's estimated that one in five children around the age of two will be affected by glue ear at any given time. 

Causes

While it is not known exactly what causes glue ear, several things have been identified that may increase the risk of children developing the condition.

With glue ear, the Eustachian tube seems to lose the ability to drain away the mucus. The mucus builds up inside the ear, which leads to glue ear. 

The reasons for this loss of function are still unclear, but some suggestions include:

• changes in air pressure inside the ear that lead to a blockage in the Eustachian tube
• inflammation of the Eustachian tube caused by allergic rhinitis, infection or irritants such as cigarette smoke, which causes the tube to narrow
• gastric fluids from the stomach that leak up through the throat and into the Eustachian tube
• inflammation and swelling of the adenoid glands (small lumps of tissue located at the back of the throat that form part of a child's immune system).

Other reasons for glue ear include:

• being bottlefed rather than breastfed
• having contact with lots of other children, such as at a nursery (this may be because of a higher risk of infection)
• cleft palate, (a birth defect where a child has a split in the roof of their mouth)
• Down's syndrome (a genetic disorder that causes learning difficulties and disrupts physical development)
• cystic fibrosis, (agenetic condition that causes the lungs to clog up with thick, sticky mucus)

Symptoms

Glue ear is often not obvious and it usually goes undetected. Often the first thing a parent notices is hearing loss.

Signs that your child may be having problems hearing include: 

• struggling to keep up with conversations and seems inattentive
• becoming aggravated because they are trying harder to hear
• regularly turning up the volume on the TV

Other symptoms that may occur include:

• ear pain
• disturbed sleep
• a feeling of fullness in the ear (this is unusual for young children to articulate)
• ringing in the ear (occasionally mentioned by older children)
• balance problems
• speech delay
• recurrent acute otitis media superimposed on underlying glue ear.

Whether or not fluid is present can be confirmed by an ear examination.

Diagnosis

Otoscopy and ear microscopy is used to evaluate the changes in the external ear canal and eardrum.
Other tests, such as tympanometry, may also be used to examine the middle ear. Tympanometry measures pressure differences between the middle ear and outer ear by measuring how easily the eardrum vibrates back and forth.
To measure whether the fluid is causing hearing loss, a separate hearing test or audiometry is necessary.

Treatment

Most cases of glue ear don't require treatment as the condition will improve  spontaneously, usually within three months.

Treatment is normally only recommended when symptoms last longer than three months and the hearing loss is thought to be significant enough to interfere with a child's speech and language development.

In these circumstances, glue ear can usually be treated using minor surgery, which involves placing small tubes (grommets) in the ear to help drain away the fluid.

Sometimes adenoid hyperplasia may cause obstruction of the Eustachian tubes and therefore be the reason for glue ear. In these cases adenoidectomy is performed and very often at the same time as a grommet insertion.

Earache

Earache is very common medical problem for both children and adults. The pain of earache results from inflammation and swelling of the structures that make up the ear, including the external auditory canal, the tympanic membrane, and the middle ear.

Earache can be a sharp, dull or burning ear pain that comes and goes or is constant. One or both ears may be affected.

Causes

The eustachian tube runs from the middle part of each ear to the back of the throat. This tube drains fluid that is made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. This may lead to pressure behind the eardrum or an ear infection.

• glue ear : a build-up of fluid deep inside the ear (behind the eardrum), which mainly affects children
• an infection in the ear canal (outer side of the eardrum)
• physical damage to the inside of the ear caused by a cotton bud, stick or similar 
• a plug of earwax or another object stuck inside the ear
• ear injury from pressure changes (from high altitudes and other causes)

Referred pain from other anatomically related areas may cause earache:

• arthritis of the jaw
• temporomandibular joint syndrome (TMJ)
• a throat infection, such as tonsillitis or quinsy, which can affect the ear

Vertigo & Dizziness

What is vertigo?

Vertigo is the feeling that you or your environment is moving , tilting, spinning or falling. It differs from dizziness in that vertigo describes an illusion of movement. When you feel as if you yourself are moving, it's called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo. 

During severe vertigo, you may feel very nauseated or vomit. You may have trouble walking or standing, and you may lose your balance and fall
Unlike nonspecific lightheadedness or dizziness, vertigo has relatively few causes.

What causes vertigo? 

Vertigo occurs when there is conflict between the signals sent to the brain by various balance- and position-sensing systems of the body. Your brain uses input from four sensory systems to maintain your sense of balance and orientation to your surroundings.

Vision gives you information about your position and motion in relationship to the rest of the world. This is an important part of the balance mechanism and often overrides information from the other balance-sensing systems.
Sensory nerves in your joints allow your brain to keep track of the position of your legs, arms, and torso. Your body is then automatically able to make tiny changes in posture that help you maintain your balance (proprioception).
A portion of the inner ear , called the labyrinth, which includes the semicircular canals, contains specialized cells that detect motion and changes in position. Injury to or diseases of the inner ear can send false signals to the brain indicating that the balance mechanism of the inner ear (labyrinth) detects motion. If these false signals conflict with signals from the other balance and positioning centers of the body, vertigo may occur.

Common causes of vertigo include

• Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is characterized by the sensation of motion initiated by sudden head movements or moving the head in a certain direction. This type of vertigo is rarely serious and can be treated. 
• Vertigo may also be caused by inflammation within the inner ear (labyrinthitis or vestibular neuritis), which is characterized by the sudden onset of vertigo and may be associated with hearing loss. The most common cause of labyrinthitis is a viral or bacterial inner ear infection. 
• Meniere's disease is composed of a triad of symptoms including: episodes of vertigo, ringing in the ears (tinnitis), and hearing loss. People with this condition have the abrupt onset of severe vertigo, fluctuating hearing loss, as well as periods in which they are symptom-free. 
• Acoustic neuroma is a type of tumor of the nerve tissue that can cause vertigo. Symptoms include vertigo with one-sided ringing in the ear and hearing loss. 
• Vertigo can be caused by decreased blood flow to the base of the brain. Bleeding into the back of the brain (cerebellar hemorrhage) is characterized by vertigo, headache, difficulty walking, and inability to look toward the side of the bleed.
• Vertigo is often the presenting symptom in multiple sclerosis. The onset is usually abrupt, and examination of the eyes may reveal the inability of the eyes to move past the midline toward the nose. 
• Head trauma and neck injury may also result in vertigo, which usually goes away on its own. 
• Migraine, a severe form of headache, may also cause vertigo. The vertigo is usually followed by a headache. There is often a prior history of similar episodes but no lasting problems.
• Complications from diabetes can cause arteriosclerosis (hardening of the arteries) which can lead to lowered blood flow to the brain, causing vertigo symptoms. 

Vertigo prevention

• People whose balance is affected by vertigo should take precautions to prevent injuries from falls. 
• Those with risk factors for stroke should control their high blood pressure and high cholesterol and stop smoking.
• Individuals with Meniere's disease should limit salt in their diet. Christina ENT surgeon 

Treatment

Vertigo Medical Treatment 

The choice of treatment will depend on the diagnosis.
Vertigo can be treated with medicine taken by mouth, or drugs given through an IV, to alleviate the symptoms.
In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.
Vestibular rehabilitation exercises, also referred to as Epley maneuvers, consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases.

Other vertigo exercises:

1. Eye exercises, can help people with vertigo overcome this uncomfortable sensation, by turning the eyes upward and then downward for 20.repetitions
2. One head exercise to treat vertigo is the side-to-side turning exercise (Hamid's Exercise). This exercise is exactly as simple as it sounds, but will likely produce feelings of dizziness.
3. Brandt-Daroff Exercise can help with vertigo. This exercise is much simpler than the vestibular rehabilitation exercise. It only entails leaning to whichever side of the body that elicits the most severe sensation of vertigo. In a seated position, quickly lean to one side until your ear rests on the bed or sofa on which you're sitting. Allow the dizziness to subside before returning to an upright position. Repeat 20 times twice a day. If you also experience dizziness while returning to an upright position, allow the sensation to subside before leaning again.

Sinusitis

Rhino-Sinusitis

What is sinusitis?

The sinuses are a connected system of hollow cavities in the skull surrounding the nose.The paranasal sinuses open into the nasal cavity and are lined with cells that make mucus to keep the nose from drying out during breathing and to trap unwanted materials so that they do not reach the lungs.Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses.
There are several types of sinusitis. 

Health experts usually identify them as follows:

• Acute, which lasts up to 4 weeks
• Subacute, which lasts 4 to 12 weeks
• Chronic, which lasts more than 12 weeks and can continue for months or even years
• Recurrent, with several attacks within a year.

Symptoms

• Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat
• Nasal obstruction or congestion, causing difficulty breathing through your nose
• Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead
• Aching in your upper jaw and teeth
• Reduced sense of smell and taste
• Cough, which may be worse at night.

Other signs and symptoms can include: 

• Ear pain
• Headache
• Sore throat
• Bad breath (halitosis)
• Fatigue
• Fever

When to see a doctor:
Symptoms that don't improve within a few days or symptoms that get worse
A persistent fever
A history of recurrent or chronic sinusitis

Diagnosis

Physical exam.

To look for the cause of your symptoms, your doctor will feel for tenderness in your nose or throat. Your doctor may use a tool to hold your nose open and apply medication that constricts blood vessels in your nasal passages. Your doctor will then shine a light into your nasal passages to look for inflammation or fluid. This visual inspection will also help rule out physical conditions that trigger sinusitis, such as nasal polyps or other abnormalities.

Nasal endoscopy. 

A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses

Imaging studies. 

Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical obstruction that's difficult to detect using an endoscope.

Nasal and sinus cultures. 

Laboratory tests are generally unnecessary for diagnosing acute sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial cause.

Allergy testing. 

If your doctor suspects that the condition may be brought on by allergies, an allergy skin test may be recommended. A skin test is safe and quick, and can help pinpoint the allergen that's responsible for your nasal flare-ups.

Treatment

Acute sinusitis

• Antibiotics to control a bacterial infection, if present
• Pain relievers to reduce any pain
• Decongestants (medicines that shrink the swollen membranes in the nose and make it easier to breathe.

Chronic sinusitis

• Nasal steroid sprays are helpful for many people..
• Saline (saltwater) washes or saline nasal sprays can be helpful in chronic rhinosinusitis because they remove thick secretions and allow the sinuses to drain.
• Oral steroids, such as prednisone, may be prescribed for severe chronic rhinosinusitis. However, oral steroids are powerful medicines with significant side effects, and these medicines typically are prescribed when other medicines have failed.
• Surgery 

When medicine fails, surgery may be the only alternative for treating chronic rhinosinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. 

Nasal surgery usually is performed to accomplish the following:

• Enlarge the natural openings of the sinuses
• Remove nasal polyps
• Correct significant structural problems inside the nose and the sinuses if they contribute to sinus obstructionAlthough most people have fewer symptoms and a better quality of life after surgery, problems can reoccur, sometimes even after a short period of time.