Skull Base Surgeon

 Receiving an autographed book from Dr. Rhoton, one of the world's top skull base surgeons and teachers, was an immense privilege. His contributions to the field of neurosurgery are unparalleled and his unwavering dedication has inspired countless individuals worldwide.

Receiving a personalized message from such a distinguished figure is not only a testament to one's own hard work and achievements but also serves as a reminder to continue making a positive difference in the lives of others. It is an experience that will be cherished for a lifetime.

I am ever grateful to my mentor, guide, and friend, the current Chairman at Lehigh Valley Health Network, Prof. Ravi Samy, and to the then Chairman at University of Cincinnati, Prof. Myles Pensak, for providing me with these opportunities.

Services

 

Ear Itching - What Are the Reasons and What Can Be Done...

Ear canal skin is very sensitive. All kinds of things can start an ear itch. The slightest accumulation of debris, even a dead hair, may be felt as an itching sensation. A normal ear has a thin layer of natural body oil but some ears produce no ear wax which results in dry and itchy ear skin due to accumulation of flakes of dry dead skin.

Causes of itchy ears:                                                                                             
Having skin conditions like eczema, psoriasis and seborrheic dermatitis (the same troublemaker responsible for dandruff) is a clue that it could be responsible for the ear itch.
Moisture caused by earwax build-up or excessive ear cleaning can also cause itching ears. It is true that oftentimes itchiness of the ears (inside the ear, usually) can be caused by allergy. Swimmer’s ear or acute otitis externa, is an infection of the outer ear and ear canal, often resulting from water becoming trapped in the ear. Fungal infections in the ear canal have also been known to cause ear itching.

Symptom Relief
General principles are to avoid aggressive cleaning and to keep the ear dry. When the itch starts, here’s what to do.
Don’t try to scratch it. Sticking a cotton swab—or if you’re really foolish, a house key or paper clip—in your ear could damage your eardrum. “Doctors have an old saying: Never stick anything smaller than your elbow in your ear. And I mean it”.
Oil that itch. A drop or two of mineral oil, olive oil or some other vegetable oil can soothe an itchy ear instantly.
Remove the earwax. Meet with an Otolaryngologist or use wax solvents to remove the wax. However remember that a little earwax actually helps prevent itching.
Treat the underlying skin problem. Meet with your skin specialist and treat the cause.
See your doctor. Because it’s difficult to see many of the causes of itching—like a fungal infection—you may benefit from consulting with your doctor if the itching persists for more than a few days.

Ear Bud Damage - Perichondritis - Permanent Change in Shape and Function of Pinna - External Ear

Dont know when people will realise that #earbuds whatever brand they may will cause harm
This patient used ear buds and his ears are gone and the shape is lost.
This condition is called Perichondritis

Tongue Tie - Has Major Implications - Check it and Get it Cured before its Too Late

 Tongue-tie is the non-medical term for a condition that limits the use of the tongue. Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. As we grow, it recedes and thins. This frenulum is visible and easily felt if you look in the mirror under your tongue. 

In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems. In tongue-tie, the free movement of the tongue is restricted due to abnormal attachment of the base of the tongue (lingual frenulum) towards the tip of the tongue.

                                    

                                   Problems Associated with Tongue Tie

Feeding – A new baby with a too tight frenulum can have trouble sucking and may have poor weight gain. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie.  

Speech - In some children, tongue tie may also cause speech defects, preventing speech defects may be another reason to consider surgical intervention. Although, there is no obvious way to tell in infancy which children will have speech difficulties later, the following associated characteristics are common:

• V-shaped notch at the tip of the tongue
• Inability to stick out the tongue past the upper gums
• Inability to touch the roof of the mouth
• Difficulty moving the tongue from side to side

Dental - Tongue tie may contribute to dental problems as well, causing a persistent gap between the bottom two front teeth.

                               

                                             Does My Child Need Surgery for Tongue Tie?                                          

Tongue tie often resolves on its own after two or three years of age. As a child grows and develops, the frenulum often continues to recede (normally it recedes before birth), lessening the abnormality. Unless feeding is a problem, it is recommended to wait at least a year before considering surgery. If tongue tie interferes with a baby’s feeding, early intervention is usually warranted

Tongue-tie surgery (frenulectomy) is a simple procedure and there are normally no complications. Parents should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.

Ears and Flying - What causes Pain and How to Avoid It?

 Ear problems are the most common medical complaint of airplane travelers and sometimes may result in hearing loss. Make air travel comfortable by learning how to equalize the pressure in the ears instead of suffering from an uncomfortable feeling or fullness or pressure.

 

Why do ears pop?

The air in the middle ear is constantly reabsorbed by its lining and re-supplied through the eustachian tube (tube that connects the back of the nose with the middle ear). In this manner, air pressure on both sides of the eardrum stays about equal. If and when, the air pressure is not equal the ear feels blocked.

The eustachian tube can be blocked or obstructed for a variety of reasons. When that occurs the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs sucking the eardrum inwards and stretching it. Fluid then sweeps into the area from the lining membranes in an attempt to overcome the vacuum.

 

How can air travel cause hearing problems?

Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down to earth where the air pressure is higher.

 

How to unblock the ears?

Swallowing activates the muscles that open the eustachian tube. Swallowing occurs more often when chewing gum or when sucking on hard candies. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent because swallowing may not occur often enough to keep up with the pressure changes.

Even after landing, continue the pressure equalizing techniques and if pain persists or the ears fail to open, consult an ENT specialist.

 

How to help babies unblock their ears?

Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed the baby during the flight and do not allow him/her to sleep during descent. Children are especially vulnerable to blockages because their eustachian tubes are narrower than adults.

 

Tips to prevent discomfort during air travel

1. Postpone an airplane trip if a cold, sinus infection or an allergy attack is present.
2. You can use a nasal decongestant spray approximately an hour before descent to help the ears pop more easily.
3. An anti histamine pill also helps
4. Avoid sleeping during descent
5. Chew gum or suck on hard candy just before take off and during descent.

When inflating the ears do not use force.

Laryngitis

                                                          

 

What is laryngitis?

The larynx joins the back of the throat to the trachea (windpipe). Laryngitis is inflammation of the larynx, usually due to a virus or overuse. The result is acute change in the voice. Viral laryngitis is self-limited. Other infectious or irritating causes may require specific treatment. 

Why does the voice become hoarse and can it get severe?

 The voice becomes hoarse because the vocal cords are thickened by inflammation and the areas around the cords also become thickened. Yes, when people try to talk when they have laryngitis it can lead to permanent damage to the vocal cords and long standing hoarseness of voice.

What are the symptoms of viral laryngitis?

You may feel sore over the 'Adams apple' and become hoarse shortly afterwards. You may also have a mild fever, and a cough. Breathing difficulty is an uncommon complication. This may occur if there is a lot of inflammation and swelling in the larynx which causes the windpipe to narrow. This is rare in adults, but sometimes happens in young children with smaller, narrower windpipes. 

 

Do I need an antibiotic?

Usually not. Laryngitis is usually caused by a virus. Antibiotics do not kill viruses, they only kill bacteria. Your immune system usually clears virus infections quickly.

A more severe laryngitis is sometimes due to bacteria. An antibiotic may be advised if the infection is severe, if it is not easing after a few days, or if your immune system is not working properly (for example, if you have had your spleen removed or if you are taking chemotherapy, etc).

 

Other causes of laryngitis and hoarseness

Laryngitis and hoarseness are occasionally due to other conditions that affect the vocal cords. For example: rare infections, allergies, voice overuse, tobacco smoke, or other irritants or chemicals that you may inhale. A benign (non-cancerous) cyst on a vocal cord sometimes causes hoarseness. A tumor (cancer) on the vocal cord is an uncommon cause. See a doctor if any of the following develop.

• Symptoms that are severe, or are different to those described above.
• Any flu-like symptoms which do not ease within 3-4 days.
• If hoarseness or soreness in the larynx persist more than 2-3 weeks. Particularly if you had no initial infection to account for the hoarseness.
• If swollen neck glands do not go within 2-3 weeks after an infection.
• If swollen glands appear in the neck without symptoms of infection.
  
  
  

What is Pediatric Sleep Apnea? What is the Main Cause

 

Chronic running nose, mouth breathing, dry Mouth frequent infections especially of the lungs, poor appetite, halitosis, nasal congestion, and ADHD like symptoms mainly aggression, poor concentration, and irritability rather than to act or complain of feeling “sleepy.”

Since OSA results from relative narrowing of upper airway rather than the absolute size of the tonsils and adenoids, tonsillar size Adenotonsillectomy is an effective first-line treatment for pediatric OSA.

Failure to thrive because of pediatric OSA is also corrected with Adenotonsillectomy and shown to increase the height and weight of children

MISDIAGNOSING SLEEP APNEA AS ADHD

Attention deficit hyperactivity disorder, also known as ADHD, is a common condition diagnosed due to symptoms indicating hyperactivity, inattentiveness, and impulsivity. Attention-deficit/hyperactivity disorder is among the neurobehavioral sequelae associated with OSA in nearly 75 percent of children. 

OSAS in children is a similar condition to the form in adults in children.

· If left untreated, OSAS is associated with adverse effects on growth and development, and can cause metabolic, cardiovascular and neurocognitive disease and behavioural changes in children.

· Daytime hyperactivity.

· Cognitive deficits.

· Cardiovascular problems - eg, hypertension, left ventricular hypertrophy, raised pulmonary artery pressure.

· Failure to thrive.

· Association with insulin resistance.

· Some studies have shown that children with OSAS have greater impulsivity when crossing streets which increases their risk of injury.

· School-aged children are at risk of developing future obesity if they have OSAS.

 

Sudden Deafness to Normal Hearing - Timing is the Essence, when to meet the Specialist

Its sad that most patients do not realize or think that their decreased hearing is because of some Ear wax and make their problem worse.

Timing is of utmost importance in treating sudden deafness, the most unfortunate part is many come after a month after trying all home remedies!. 

Even more sad part is the presentation of the condition, it majority of the times presents just like Ear blockage or as ringing noise, if you have these symptoms and even after 3-4 days if it persists meet your specialist. 

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Coping With Stress

 What are the possible signs and symptoms of stress?

Stress affects the mind, body, and behavior in many ways and has the potential to harm your health, emotional well-being, and relationships with others. 

 

How stress can affect your mind	How stress can make you feel
·                Memory problems. ·                Difficulty making decisions. ·                Inability to concentrate. ·                Seeing only the negative. ·                Repetitive or racing thoughts.  ·                Poor judgment.	·                Moody and hypersensitive. ·                Restlessness and anxiety. ·                Depression. ·                Anger and irritability ·                Sense of being overwhelmed. ·                Lack of confidence.
How stress can affect your body	How stress can affect your behavior
·                Headaches. ·                Digestive problems. ·                Muscle tension and pain. ·                Sleep disturbances. ·                Fatigue. ·                Chest pain. ·                High blood pressure. ·                Weight gain or loss. ·                Asthma or shortness of breath. ·                Skin problems.	·                Eating more or less. ·                Sleeping too much or too little. ·                Neglecting your responsibilities. ·                Increasing alcohol and drug use. ·                Nervous habits (e.g. nail biting, pacing). ·                Teeth grinding or jaw clenching. ·                Overdoing activities such as shopping. ·                Losing your temper. ·                Overreacting to unexpected problems.

 

Health Problems Linked to Stress
·                Heart attack ·                Hypertension ·                Stroke ·                Diabetes ·                Depression ·                Obesity ·                Eating disorders	·                Substance abuse ·                Ulcers ·                Irritable bowel syndrome ·                Memory loss ·                Insomnia ·                Thyroid problems ·                Infertility

 

How can I change my lifestyle habits to manage stress better?

§  Get enough sleep.

§  Connect with others and share your feelings.

§  Exercise regularly. Nothing beats aerobic exercise to dissipate the excess energy. Physical activity plays a key role in reducing and preventing the effects of stress.

§  Eat a balanced, nutritious diet. Take time to eat breakfast in the morning, it will help keep you going throughout the day.

§  Reduce caffeine and sugar. You’ll feel more relaxed, less jittery or nervous, and you’ll sleep better.

§  Don’t self-medicate with alcohol or drugs. These lessen stress only temporary. Don’t mask the issue at hand; deal with it head on and with a clear mind.

§  Do something for yourself everyday. Too much work is actually inefficient and can lead to burnout. Recognize when you are most stressed and allow yourself some reasonable breaks. Most importantly do things that make you happy.

 

How can I handle stress better?

§  Have realistic expectations: Know your limits. Whether personally or professionally, be realistic about how much you can do. Set limits for yourself and learn to say “no” to more work and commitments.

§  Reframe problems: See problems as opportunities. As a result of positive thinking, you will be able to handle whatever is causing your stress. Refute negative thoughts and try to see the glass as half full. Your thoughts can become like a pair of dark glasses, allowing little light or joy into your life.

§  Maintain your sense of humor: This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.

§  Express your feelings instead of bottling them up: In order to live a less stressful life, learn to calm your emotions.

§  Don’t try to control events or other people: Many circumstances in life are beyond your control, particularly the behavior of others. Consider that we live in an imperfect world. Learn to accept what is, for now, until the time comes when perhaps you can change things.

§  Ask yourself “Is this my problem?” If it isn't, leave it alone. If it is, can you resolve it now? Once the problem is settled, leave it alone. Don't agonize over the decision, and try to accept situations you cannot change.