Frequently Asked Questions
In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and changes shape even more, glasses or soft contacts will no longer correct your vision.
Rigid gas permeable contact lenses can also be used for some cases. The firmer material of a rigid contact lens holds the cornea in place better than a soft contact lens. Fitting contact lenses on a keratoconus cornea is delicate and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription. The process will begin again when the cornea thins and distorts even more, altering the contact lens fit and prescription needed for clear, comfortable vision.
A new treatment for keratoconus is corneal inserts. Intacs corneal rings received can be used to correct or reduce nearsightedness and astigmatism in keratoconus patients who can no longer obtain functional vision with contact lenses or eyeglasses. The procedure involves placing the plastic inserts just under the surface of the eye in the periphery of the cornea. The result is a flatter cornea and clearer vision. Take a look at the Intacs procedure at our Vision Correction corner under Keratoconus treatment.
Some people with keratoconus can’t tolerate a rigid contact lens, or they reach the point where contact lenses or corneal inserts no longer provide acceptable vision. The next step may be a corneal transplant, also called a penetrating keratoplasty. Even after a transplant, you most likely will need glasses or contact lenses for clear vision.
Keratoconus can be difficult to detect, because it comes on slowly. Nearsightedness and astigmatism also accompany this disease, so you may have distorted and blurred vision. You might also notice glare and light sensitivity. Keratoconic patients often have prescription changes each time they visit their eyecare practitioner. It?s not unusual to have a delayed diagnosis of keratoconus, if the practitioner is not familiar with the early-stage symptoms of the disease.
Keratoconus is a progressive disease, often appearing in the teens or early twenties, in which the cornea thins and changes shape. The cornea is normally a round or spherical shape, but with keratoconus the cornea bulges, distorts and assumes more of a cone shape. This affects the way light enters the eye and hits the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.
- You will need to go through an in-depth pre-surgical evaluation. Eye surgeons and optometrists will check your eyes thoroughly. Some of the factors that determine your suitability for Trans PRK are:
- Corneal shape
- Corneal thickness
- Any pre-existing eye conditions such as glaucoma, cataracts, etc.
This new technology is used to correct vision errors such as myopia, hyperopia and astigmatism. The SCHWIND AMARIS laser system provides a sophisticated approach to carry out no-touch, all-laser surface ablations in a single step. Precise ablation with the laser With the Trans PRK (trans epithelial PRK), the epithelium is ablated by SCHWIND AMARIS laser systems.Also Trans PRK is also an advanced surface laser treatment because the epithelium is removed more precisely, uniformly and easily than with either manual or alcohol-assisted debridement.
– Preserving the cornea.
– Preserving corneal nerves.
– Possibility of treating higher degrees of vision errors.
– No pain during or after the procedure.
– A candidate can resume daily life the second day after Femto smile.
– Less chance of eye dryness after the procedure.
Femto smile is the latest technology in vision correction to treat nearsightedness, farsightedness and astigmatism. The procedure is totally ‘flap-less’, and involves a tiny incision being made in the cornea. The surgeon then removes a precise amount of tissue through this incision. Because there are no moving parts, the healing time for SMILE is even quicker than with conventional LASIK. There is much less incidence of dry eye and night vision disturbance, and the procedure is suitable for even those patients with very high prescriptions, drier eyes and thinner corneas.
Based on a decade of studies with the laser and a century of research on corneal healing, most experts in the field feel confident that nothing will change long-term. There has been no evidence whatsoever of any long-term problems to date. With LASIK, because the epithelium is not removed and Bowman?s membrane is not disrupted, a variable healing process is not introduced, long-term results are much more predictable.
Gentle exercise for the first 2 weeks after treatment is fine, after which you can resume more strenuous activity, such as going to the gym. However, we advise to avoid contact sports for 2 months after treatment.
Vision stabilizes more rapidly after a LASIK procedure. Most patients are able to drive the next day, and will see a dramatic improvement in their vision by the end of the first week.
It is generally advisable to rest and stay home from work the day of treatment and possibly the first day following laser vision correction. By the end of the second day, most patients are able to return to work and resume normal activities, including sports. The risk of infection is low; however, patients must be careful for the first week to avoid certain activities like swimming and gardening.
You need to discuss these concerns with your doctor to determine if you are a good candidate for Lasik. The technology we use provides the doctor with the necessary flexibility in planning your personalized treatment.
Patients return the following day for their post-operative check-up. All patients remain under the specialist’s care for 6-9 months. Each of our treatment types has its own specific aftercare program.
Yes. At your consultation we may instill eye drops to dilate your pupils. This can cause your vision to become slightly blurred for a few hours after the consultation, and we strongly advise against driving yourself home. Likewise, on the day of treatment, your vision will take a while to stabilize and you will not be able to drive yourself home. Please bring someone with you to both your consultation and your treatment appointments to accompany you home.
No, you can go home after treatment, but you will need to return to Magrabi for your next-day check-up. Each of our treatment types has its own specific aftercare program, which is explained fully at consultation.
The lower age limit for laser eye treatment is usually 19, when the eye has finished its normal growth, provided that their prescription has been stable for a minimum of one year.
Laser eye treatment cannot delay the onset of Presbyopia, the age-related condition that affects most of us as we reach our 40s, which results in the need for reading glasses. However, Magrabi Hospitals & Centers is proud to be the second in the world to offer a treatment solution for Presbyopia. You can check the surgery for Presbyopia section.
Although we can’t tell for certain without seeing you for a consultation, Lasik treatment is considered the appropriate treatment for around 80% of those coming for consultation.
Soft contact lenses must be removed one week prior to laser vision correction. Toric lenses, two weeks prior, and hard or gas permeable contact lenses must be removed for two to four weeks.
A pre-operative consultation and examination is necessary to determine whether a person is a good candidate for laser vision correction. An ophthalmologist or optometrist will review specific details of the laser procedure, including what to expect before, during, and after the procedure.
Magrabi Hospitals & centers has been performing laser eye procedures since 1991 and we know that patients from these early days still have great unaided vision today. However, it cannot prevent the eyes’ natural ageing process. A small number of patients may require re-treatment (or ‘enhancement’) in order to achieve the best overall result and if this is recommended, it is usually within the first year.
Experience has shown that laser vision correction has been overwhelmingly successful in reducing myopia, astigmatism, and hyperopia. Overall, more than 98% of patients do not need to wear glasses after being treated. These patients are able to drive comfortably, play sports, or just watch TV without the hassle of corrective lenses. The success rate is directly related to the skill of the surgeon, quality post-operative monitoring, and the type of laser utilized.
Laser vision correction is based on precise measurements of the imperfections in your vision. The measurements are taken with a powerful measurement tool known as the WaveScan?. The WaveScan information is transferred to the laser to guide the treatment.
Lasik is a procedure that improves vision by permanently changing the shape of the cornea (the clear covering of the front of the eye) with laser. It is the most commonly performed type of laser procedures and an effective treatment for a wide range of vision problems.
A laser is a technology that utilizes ultraviolet light to precisely reshape the inner layers of the cornea. This reshaping is capable of correcting nearsighted, farsighted and astigmatic persons.
Presbyopia is caused by an age-related process. This is different from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and caused by genetic factors, disease, or trauma. Presbyopia is generally believed to stem from a gradual loss of flexibility in the natural lens inside your eye. These age-related changes occur within the proteins in the lens, making the lens harder and less elastic with the years. Age-related changes also take place in the muscle fibers surrounding the lens. With less elasticity, the eye has a harder time focusing up close. Other, less popular theories exist as well.
When people develop presbyopia, they find they need to hold books, magazines, newspapers, menus and other reading materials at arm’s length in order to focus properly. When they perform near work, such as embroidery or handwriting, they may have headaches or eyestrain, or feel fatigued.
During middle age, usually beginning in the 40s, people experience blurred vision at near points, such as when reading, sewing or working at the computer. There’s no getting around it ? this happens to everyone at some point in life, even those who have never had a vision problem before. Currently an estimated 90 million people in the United States either have presbyopia or will develop it by 2014. This is generating a huge demand for eyewear, contact lenses, and surgery that can help presbyopes deal with their failing near vision.
Astigmatism can be corrected with eyeglasses or contact lenses. Many people with astigmatism believe that they can’t wear contact lenses, or that only rigid contact lenses (RGPs) can correct astigmatism ? but this is no longer true. Now there are soft lens designs that correct astigmatism; they are called toric contact lenses. Toric lenses have a special correction built into them and may also contain a prescription for nearsightedness or farsightedness if you need it. While soft torics work well for many people, if you have severe astigmatism, you’ll likely do better with RGP contacts or eyeglasses. Your eyecare practitioner will advise you. Depending on the type and severity of your astigmatism, you may also be able to have it corrected with refractive surgery. Discuss with your eye doctor which procedure is best to correct your astigmatism, and review your options in our Vision Correction corner .
Astigmatism occurs when the cornea is shaped more like an oblong football than a spherical baseball, which is the normal shape. The oblong shape causes light rays to focus on two points in the back of your eye, rather than on just one. Many people are born with this oblong cornea, and the resulting vision problem may get worse over time.
If you have only a small amount of astigmatism, you may not notice it or have just slightly blurred vision. Sometimes uncorrected astigmatism can give you headaches or eyestrain, and distort or blur your vision at all distances.
Astigmatism is the most common vision problem among people. Sometimes incorrectly called a “stigmatism,” astigmatism may accompany nearsightedness or farsightedness. It’s caused by an irregularly shaped cornea and is corrected with eyeglasses, contact lenses or refractive surgery.
Farsightedness can be corrected with glasses or contact lenses to change the way light rays bend into the eyes. If your glasses or contact lens prescription begins with plus numbers, like +2.50, you are farsighted. You may need to wear your glasses or contacts all the time, or only when reading, working on a computer, or doing other close-up work. Refractive surgery, such as LASIK or CK (Conductive Keratoplasty), Intra-corneal Lenses and Lens Implants are all options for correcting hyperopia. They may reduce or eliminate your need to wear glasses or contact lenses. Check our Vision Correction corner to see what’s there for your case. You can find this whole range only in Magrabi Hospitals & Centers.
This vision problem occurs when light rays entering the eye focus behind the retina, rather than directly on it. The eyeball of a farsighted person is shorter than normal. Many children are born with hyperopia, and some of them “outgrow” it as the eyeball lengthens with normal growth. Sometimes people confuse hyperopia with presbyopia, which also is a difficulty in seeing up close, but has a different cause.
Farsighted people sometimes have headaches or eyestrain, and may squint or feel fatigued when performing work at close range. If you get these symptoms while wearing your glasses or contact lenses, you may need an eye exam and a new prescription.
Hyperopia, or farsightedness, is a common vision problem, affecting about a fourth of the population. People with hyperopia can see distant objects very well, but have difficulty seeing objects that are up close.
Nearsightedness may be corrected with glasses, contact lenses or refractive surgery. Depending on your vision problem, you may need to wear your glasses or contact lenses all the time, or only when you need distance vision, like driving, seeing a chalkboard or watching a movie. With myopia, your prescription is a negative number. The higher the numeral, the stronger your lenses will be. Refractive surgery can reduce or even eliminate your need for glasses or contacts. The most common procedures are performed with an excimer laser. In photorefractive keratectomy, or PRK, the laser removes a layer of corneal tissue, which flattens the cornea and allows light rays to focus closer to or even on the retina. In laser-assisted in situ keratomileusis (LASIK) ? the most common refractive procedure ? a flap is cut through the top of the cornea, a laser removes some corneal tissue, and then the flap is dropped back into place. Also, at Magrabi we provide the latest techniques to treat Myopia like LASEK and EPILASIK. You check our Vision Correction Corner and review the different options.
Myopia occurs when the eyeball is slightly longer than usual from front to back. This causes light rays to focus at a point in front of the retina, rather than directly on its surface. Nearsightedness runs in families and usually appears in childhood. This vision problem may stabilize at a certain point, although sometimes it worsens with age. This is known as myopic creep.
Myopic people often have headaches or eyestrain, and might squint or feel fatigued when driving or playing sports. If you experience these symptoms while wearing your glasses or contact lenses, you may need a comprehensive eye examination as well as a new prescription.
Nearsightedness, or myopia, is a vision problem experienced by up to about one-third of the population. Nearsighted people have difficulty reading highway signs and seeing other objects at a distance, but can see for up-close tasks such as reading or sewing.
All surgery involves some risk. However, cataract surgery is one of the most commonly performed type of surgery. Magrabi cataract surgeons have performed thousands of cataracts. Choosing a surgeon with this much experience will reduce the risk of something going wrong.
As with any surgery, pain, infection, swelling, and bleeding are possible, but very few patients experience serious problems. Your surgeon may prescribe medications for these effects. Retinal detachment also occurs in a few people. Be on the lookout for excessive pain, vision loss, or nausea, and report these symptoms to your eye surgeon immediately.
Nowadays, cataract patients who have intraocular lenses (IOLs) implanted during surgery may need only reading glasses for close vision, but that’s about it. People who don’t receive IOLs wear contact lenses for distance vision, with reading glasses for close up. Or they may wear multifocal contact lenses for all distances. Rarely does anyone have to wear thick eyeglasses now.
About half of the population has a cataract by age 65, and nearly everyone over 75 has at least one. But in rare cases, infants can have congenital cataracts at birth. These are usually related to the mother having German measles, chickenpox, or another infectious disease during pregnancy, but sometimes they are inherited.
Cataracts usually start as very small and practically unnoticeable but grow gradually larger and cloudier. Your doctor is probably waiting until the cataract interferes significantly with your vision and your lifestyle. You need to continue to visit your eye doctor regularly so the cataract’s progress is monitored. Some cataracts never really reach the stage where they should be removed. If your cataract is interfering with your vision to the point where it is unsafe to drive, or doing everyday tasks is difficult, then it’s time to discuss surgery with your doctor.
A cataract is a cloudiness of the eye’s natural lens, which lies between the front and back areas of the eye. This makes it difficult for light to pass through it causing poor cloudy vision.
Femtolaser is recently used in cataract surgery to facilitate the removal of the eye lens.
Also, YAG lasers are used in a later procedure to create a clear opening in the lens-containing membrane, if the membrane becomes cloudy in the months following the original cataract removal. Also, at Magrabi we use laser to break up the cloudy lens before removing it. This helps to make the incision wound very small (2 mm).
A small incision is made into the eye. The surgeon will either remove the lens as is, or use ultrasound, a laser or surgical solution to break it up, and then remove it. The back membrane of the lens (called the posterior capsule) is left in place. Usually, a replacement lens (called an intraocular lens, or IOL) is inserted.
You may not need any treatment if your eye pressure is only slightly elevated and there’s no damage to your optic nerve. Instead, your doctor may choose to monitor your condition with regular eye exams. But if you have signs of optic nerve damage, treatment can help slow its progression. Unfortunately, it’s not currently possible to reverse damage that has already occurred. Most people have good results with glaucoma medication, but some may need surgery instead.
Medications for glaucoma
Most glaucoma medications are applied directly to your eyes in the form of drops, although a few may be taken orally. Because a portion of the drops may be absorbed into your bloodstream, you sometimes may have side effects unrelated to your eyes. In addition, some medications may lose their effectiveness over time. In that case, you may need to change or add medications or have surgery to control your glaucoma. It’s not always easy to use glaucoma medication as directed. Drops usually need to be applied several times each day, and if you’re using more than one medication, you need to wait at least 5 to 10 minutes between applications. This rigorous schedule can sometimes seem time-consuming and confusing.
Furthermore, because glaucoma rarely causes symptoms in its early stages, you may not notice any change in your vision when you start using medication. Still, it’s extremely important to follow your treatment plan exactly as your doctor prescribes. Skipping even a few doses of medication can cause your glaucoma to become worse. If you have trouble with your treatment plan, tell your doctor.
Surgery for glaucoma
When medications aren’t effective or well tolerated, surgery may be an option. Keep in mind that surgery doesn’t cure glaucoma. As a result, you may need to keep using antiglaucoma medications even after surgery. In some cases, you may need a second operation.
Laser surgery (trabeculoplasty)
In this procedure, your doctor uses a beam of high energy light to shrink part of the meshwork of your eye’s drainage angle. This causes other areas of the meshwork to stretch, which helps aqueous fluid drain more easily. Laser surgery, which usually takes between 10 and 20 minutes, will likely be performed in your doctor’s office under local anesthesia. Following surgery you should have almost no discomfort, but you’ll need to continue taking eyedrops, at least for a time, and you may need more surgery within 5 years. In some cases intraocular pressure actually may increase following laser surgery. In most cases this is temporary, but sometimes the rise in pressure may be permanent, leading to further vision loss.
In this procedure a surgeon creates a new drainage pathway for fluid in the white part of your eye (sclera) using traditional surgical techniques. Many people who have had this type of surgery no longer need eyedrops. But there are also risks. In some cases, scars may form that close the drainage channels. This is a particular problem in young people, blacks and people who have had cataract surgery.
This may be an option for adults when other treatments have failed as well as for infants and children. In this procedure a small silicon tube is inserted in your eye to help drain aqueous fluid. Possible complications include the clouding of the lens of your eye (cataracts) and implant failure.
Medications and surgery for acute glaucoma
Doctors may administer several different medications during an attack of acute glaucoma in an effort to reduce eye pressure as quickly as possible. Once your eye pressure is brought under control, you may have an emergency operation known as an iridotomy to create a drainage hole in your iris. This surgery is now almost exclusively performed with lasers, which allow specialists to form an opening without making an incision in your eye. Laser iridotomy is an outpatient procedure that avoids many of the risks of traditional surgery. After treatment you can usually resume your normal activities right away.
The signs and symptoms of glaucoma vary, depending on the type of glaucoma.
Primary open-angle glaucoma
Primary open-angle glaucoma often goes undetected for years. Pressure within the eye increases gradually, with no early warning signs. But eventually, you lose more and more of your side vision until only a narrow section of your visual field remains clear. This type of glaucoma tends to affect both eyes, although you may have symptoms in just one eye first. In addition to reduced peripheral vision, the signs and symptoms of primary open angle glaucoma may include:
• Sensitivity to glare
• Trouble differentiating between varying shades of light and dark
Attacks of angle-closure glaucoma often develop suddenly, but you also may have preliminary warnings weeks or even months ahead of a severe attack. Glaucoma attacks usually occur in the evening when the light is dim and your pupils are dilated. The pain may be very severe and cause vomiting. Other signs and symptoms of acute glaucoma may include:
• Blurred vision, usually in just the eye involved
• Halos appearing around lights
• Reddening of your affected eye
This type of glaucoma is usually present at birth, but signs and symptoms — such as eyes that seem cloudy, are often watery or teary or are sensitive to light — may not appear until an infant is a few months old.
There are several types of glaucoma, including primary open-angle glaucoma, angle-closure glaucoma, congenital glaucoma and secondary glaucoma. Primary open-angle glaucoma develops slowly and painlessly when normal eye fluid known as aqueous humor doesn’t drain properly, causing pressure to build up within your eye. It accounts for 60 percent to 70 percent of all glaucoma cases.
About 10 percent of people with glaucoma have angle-closure glaucoma, which occurs suddenly and often causes dramatic symptoms. This type of glaucoma is a medical emergency and requires immediate treatment. A much smaller number of people have congenital glaucoma, which is present at birth, or secondary glaucoma, which results from trauma, chronic steroid use or disease. Still, the news about glaucoma is encouraging. When it’s detected and treated early, glaucoma need not cause blindness or even severe vision loss for most people.
Glaucoma isn’t one disease. Instead, it’s a group of diseases that cause damage to the optic nerve. In most cases, this damage is the result of increased pressure within your eye. As the optic nerve deteriorates, the patient gradually loses the ability to see to the side (peripheral vision). In time your central vision may begin to decrease as well. If glaucoma isn’t treated, it eventually may lead to total blindness.
In fact, glaucoma is the second most common cause of blindness. That’s because glaucoma often gives no warning sign until permanent damage has already occurred. In most cases the onset is so gradual you’re not aware you’ve lost some of your peripheral vision.
Most spots and eye floaters are merely annoying but harmless when they temporarily enter the field of vision, and many fade over time. People sometimes are interested in surgery to remove floaters, but doctors are willing to perform such surgery only in rare instances.
If you suddenly see new floaters, or eye floaters accompanied by flashes of light or peripheral vision loss, it could indicate serious conditions such as diabetic retinopathy; vascular abnormalities such as retinal hemorrhages or carotid artery disease, or the beginning of a retinal detachment. The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters. You should see your eye doctor immediately.
For most people, floaters occur as they grow older. The vitreous humor thickens and clumps as we age, and floaters result from the clumped vitreous gel. Sometimes pregnant women see spots caused by little bits of protein trapped within the eye. Eye injury or breakdown of the vitreous humor may also cause spots and floaters.
When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. It is a common cause of floaters, and it is more common for people who:
have undergone cataract operations;
have had YAG laser surgery of the eye;
have had inflammation inside the eye.
If a spot or shadowy shape passes in front of your field of vision or to the side, you are seeing a floater. Because they are inside your eye, they move with your eyes when you try to see them. You may also see flashes of light. These flashes occur more often in older people as the vitreous humor thickens and tugs on the light-sensitive retina. They may be a warning sign of a detached retina. Flashes also occur after a blow to the head, often called “seeing stars.”
Some people experience flashes of light that appear as jagged lines or “heat waves” in both eyes, often lasting 10-20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a migraine. If a headache follows the flashes, it is called a migraine headache. However, jagged lines or “heat waves” can occur without a headache. In this case, the light flashes are called an ophthalmic migraine, or a migraine without a headache.
You may sometimes see small specks or clouds moving in your field of vision. They are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye.
Floaters may look like specks, strands, webs or other shapes. Actually, what you are seeing are the shadows of floaters cast on the retina, the light-sensitive part of the eye.
Macular degeneration is classified as either dry or wet. The dry form is more common than the wet (about 90% of patients). It may result from the aging and thinning of macular tissues, depositing of pigment in the macula or a combination of the two. In the wet form, new blood vessels grow beneath the retina and leak blood and fluid. This leakage causes retinal cells to die and creates blind spots in central vision.
Early signs include: straight lines appearing wavy, fuzzy vision, and shadowy areas in your central vision. Your eye doctor may find indicators before you have any symptoms, so regular eye exams can mean an early diagnosis.
Doctors aren’t sure how to prevent macular degeneration. Research suggests that ultraviolet light (and possibly blue light) factors into the problem, so sunglasses could be very beneficial. What you eat also affects your macula. Researchers think that antioxidants (vitamins A, C and E), zinc, lutein, zeaxanthin and essential fatty acids all can aid in preventing macular degeneration. Exercising and quitting smoking might also be helpful.
If you’re over age 65, a smoker or have a family member with macular degeneration, you have an increased risk for macular degeneration. Also some medications can cause the disease.
Yes and the reasons for this are: more ultraviolet light in our environment due to a thinning ozone layer, people living longer, environmental pollutants, smoking, poor diet, obesity, etc..
Macular degeneration is usually age-related, affecting people over 65, so the terms are often used interchangeably. However, certain drugs can cause macular degeneration, and some cases are inherited as well.
The best treatment is to keep your diabetes under control; blood pressure control is also helpful. Your doctor may decide on laser photocoagulation to seal leaking blood vessels and destroy new blood vessel growth. If blood gets into the vitreous humor, your doctor might want to perform a procedure called a vitrectomy.
Diabetic retinopathy is classified as either nonproliferative (background) or proliferative. Nonproliferative retinopathy is the early stage, where small retinal blood vessels break and leak. In proliferative retinopathy, new blood vessels grow abnormally within the retina. This new growth can cause scarring or retinal detachment, which can lead to vision loss. The new blood vessels may also grow or bleed into the vitreous humor, the transparent gel filling the eyeball in front of the retina. Proliferative retinopathy is much more serious than the nonproliferative form and can lead to total blindness.
In the early stages of diabetic retinopathy, you might have no symptoms at all, or you might have blurred vision. In the later stages, you develop cloudy vision, blind spots or floaters.
Keeping your blood sugar at an even level can help prevent diabetic retinopathy. If you have high blood pressure, keeping that under control is helpful as well. Even controlled diabetes can lead to diabetic retinopathy, so you should have your eyes examined once a year; that way, your doctor can begin treating any retinal damage as soon as possible.
Fluctuating blood sugar levels lead to an increased risk of this disease, as does long-term diabetes. Most people don’t develop diabetic retinopathy until they’ve had diabetes for at least 10 years.
Dry eye syndrome is an ongoing condition that may not be cured (depends on the cause), but the accompanying dryness, scratching and burning can be managed. Your eyecare practitioner may prescribe artificial tears, which are lubricating eyedrops that may alleviate the dry, scratching feeling.
Restasis eyedrops (cyclosporine in a castor oil base) go one step further: they help your eyes to increase tear production. Restasis treatment is the first of its kind.
If the problem is environmental, you should always wear sunglasses when outdoors, to reduce exposure to sun, wind, and dust. Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.
Temporary or permanent silicone plugs in the lacrimal (tear) ducts keep tears in your eye from draining away as quickly. Called lacrimal plugs or punctal plugs, they can be inserted painlessly while you’re in the eye doctor’s office and are normally not felt once inserted.
A new type of punctal plug made of acrylic is a small rod that becomes a soft gel when exposed to your body heat after insertion. It is designed to accommodate to the size of any punctum canal. Advantages of this type of plug are that one size fits all so measurement is unnecessary, and nothing protrudes from the tear duct that could potentially cause irritation.
Sometimes, however, the tear ducts need to be closed surgically.
Doctors sometimes recommend special nutritional supplements for dry eyes. Studies have found that supplements containing certain essential fatty acids (linoleic and gamma-linolenic) can decrease dry eye symptoms.
If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first!
Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops plus frequent eyelid scrubs with an antibacterial shampoo.
Quite a few products are in testing for possible dry eye treatment. For example, trehalose (a carbohydrate) improved dry eye symptoms in small studies, but further testing is needed.
If contact lens wear is the cause of your dry eyes, your eyecare practitioner may want to switch you to a different lens or have you wear your lenses for fewer hours each day. In a few cases, it is recommended that contact lens wear be discontinued altogether until the dry eye problem is cleared up.
If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until the problem is resolved. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.
Avoidance. Your first line of defense is to avoid the cause of conjunctivitis. Both viral and bacterial conjunctivitis spread easily to others. Here are some tips to avoid spreading the conditions or re-infecting yourself:
- Wash your hands frequently, and avoid touching or rubbing your eyes.
- Don’t share washcloths, towels or pillowcases with anyone else, and wash these items after each use.
- Don’t share eyedrops or cosmetics such as eyeliner, eye shadow or mascara. Replace them after you’re healed, to avoid re-infection.
- Your eyecare practitioner may recommend that you discontinue contact lens wear during this time or replace your contact lenses after you’re healed.
- Warm compresses may help soothe your eyes if you have viral or bacterial conjunctivitis.
To avoid allergic conjunctivitis, keep windows and doors closed on days when the pollen is heavy. Dust and vacuum frequently to alleviate potential allergens in the home. Stay in well-ventilated areas if you’re exposed to smoke, chemicals or fumes. Cold compresses can be very soothing.
If you’ve developed giant papillary conjunctivitis, odds are you’re a contact lens wearer. You’ll need to stop wearing your contact lenses, at least for a little while. Your eye doctor may also recommend that you switch to a different type of contact lens, to prevent the conjunctivitis from recurring. For example, you might need to go from soft contacts to gas permeable ones, or vice versa, or you might need to switch to a type of lens that you replace more frequently, such as from conventional contact lenses to daily disposable ones. GPC can also result from prosthetics, stitches and more. Your eye doctor will decide if removal is appropriate.
Medication. Doctors don’t normally prescribe medication for viral conjunctivitis because it usually clears up on its own within a few days. Antibiotic eyedrops will alleviate bacterial conjunctivitis, whereas antihistamine allergy pills or eyedrops will help control allergic conjunctivitis symptoms. For giant papillary conjunctivitis, your doctor may prescribe eyedrops to reduce inflammation and itching.
Usually, conjunctivitis is a minor eye infection, but sometimes it can develop into a more serious condition. See your eye doctor for a diagnosis before using any eyedrops in your medicine cabinet from previous infections or eye problems.
Some people also experience a “foreign body sensation,” the feeling like there’s something in the eye. And, it may seem odd, but sometimes watery eyes can result from dry eye syndrome, because the excessive dryness works to overstimulate the watery component of your eye’s tears.
Persistent dryness, scratching and burning in your eyes are signs of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.
Dry eye syndrome is a chronic lack of sufficient lubrication and moisture in the eye. Its consequences range from subtle but constant irritation to ocular inflammation of the anterior (front) tissues of the eye.
Conjunctivitis may be triggered by a virus, bacteria, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Bacterial and viral systemic infections also may induce conjunctivitis.
Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize the microorganisms that colonize the eye. Tears are essential for good eye health.
In dry eye syndrome, the eye doesn’t produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.
Eyes are lubricated from three different glands around the eyes. See animation.
Punctal plugs are often very effective in relieving dry eyes. See animation.
Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson’s medications, and birth control pills; or because you live in a dry, dusty or windy climate. If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you’re staring at a computer screen all day.
Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren’s syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).
Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers. Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and the rubbing of the lenses against the conjunctiva seems to be a cause of dry eyes.
Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes. Tears are composed of three layers: the outer, oily, lipid layer; the middle, watery, lacrimal layer; and the inner, mucous or mucin layer. Each layer is produced by a different part of the eye (the lacrimal gland produces the lacrimal layer, for example), so a problem with any of those sources can result in dry eyes.
Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking and taking multivitamins can increase your risk of dry eye syndrome, and that eating a lot of omega-3 fatty acids (found in cold-water fish) may decrease your risk.
The most obvious symptom of pink eye is, of course, a pink eye. The pink or red color is due to inflammation. Your eye may also hurt or itch.
How can you tell what type of pink eye you have? The way your eyes feel will give some clues:
Viral conjunctivitis usually affects only one eye and causes excessive eye watering and a light discharge.
Bacterial conjunctivitis affects both eyes and causes a heavy discharge, sometimes greenish.
Allergic conjunctivitis affects both eyes and causes itching and redness in the eyes and sometimes the nose, as well as excessive tearing.
Giant papillary conjunctivitis (GPC) usually affects both eyes and causes contact lens intolerance, itching, a heavy discharge, tearing and red bumps on the underside of the eyelids.
To pinpoint the cause and then choose an appropriate treatment, your doctor will ask some questions, examine your eyes, and possibly collect a sample on a swab to send out for analysis.
Give a careful account of the episode, because oftentimes your answers alone with reveal the diagnosis.
Most styes heal within a few days on their own. You can encourage this process by applying hot compresses for 10 to 15 minutes, three or four times a day over the course of several days. This will relieve the pain and bring the stye to a head, much like a pimple. The stye ruptures and drains, then heals.
Never “pop” a stye like a pimple; allow it to rupture on its own. If you have frequent styes, your eye doctor may prescribe an antibiotic ointment to prevent a recurrence.
Styes formed inside the eyelid either disappear completely or (rarely) rupture on their own, and they can be more serious. These styes may need to be opened and drained by your eyecare practitioner
A stye initially brings pain, redness, tenderness and swelling in the area, then a small pimple appears. Sometimes just the immediate area is swollen; other times the entire eyelid swells. You may notice frequent watering in the affected eye, a feeling like something is in the eye or increased light sensitivity.
A stye (also spelled “sty”) develops when a gland at the edge of the eyelid becomes infected. Resembling a pimple on the eyelid, a stye can grow on the inside or outside of the lid. Styes are not harmful to vision, and they can occur at any age.
Infants and children are more susceptible to UV damage because the lenses in their eyes are clearer. Please take the following steps when taking your children outdoors:
- Keep children younger than 6 months out of direct sunlight. Choose the shade, an umbrella, or a baby stroller when outside with a very young child or infant. Make sure the stroller has a shade for the sun.
- To help ensure your children wear their sunglasses, allow them to select a style they like. Many manufacturers make frames with cartoon characters or multi-colored frames.
- Make sure your child wears a wide-brimmed hat or a baseball cap, which provides some UV protection, if he/she will not tolerate sunglasses.
- Try to keep children out of the sun between 10 a.m. and 4 p.m. The sun’s rays are the strongest at these hours.
- Be sure to wear sunglasses or a hat outside yourself. Children often follow the example of their parents.
- Remind children to wear their sunglasses or a hat even on cloudy days. Most of the sun’s rays can come through the clouds on an overcast day.
- Teach your children to never look directly or stare at the sun.
You can treat many minor eye irritations by flushing the eye, but more serious injuries require medical attention. Injuries to the eye are the most common preventable cause of blindness; so when in doubt, err on the side of caution and call for help.
Routine Irritations (sand, dirt, and other “foreign bodies” on the eye surface)
- Do not try to remove any “foreign body” except by flushing.
- Wash your hands thoroughly before touching the eyelids to examine or flush the eye.
- Do not touch, press, or rub the eye, and do whatever you can to keep the child from touching it (a baby can be swaddled as a preventive measure).
- Tilt the child’s head over a basin with the affected eye down and gently pull down the lower lid, encouraging the child to open her eyes as wide as possible. For an infant or small child, it is helpful to have a second person hold the child’s eyes open while you flush.
- Gently pour a steady stream of lukewarm water from a pitcher across the eye. Sterile saline solution can also be used.
- Flush for up to fifteen minutes, checking the eye every five minutes to see if the foreign body has been flushed out.
- Since a particle can scratch the cornea and cause an infection, the eye should be examined by a doctor if there continues to be any irritation afterwards.
- If a foreign body is not dislodged by flushing, it will probably be necessary for a trained medical practitioner to flush the eye.
What if something penetrated my child’s eye
– Call for emergency medical help.
– Cover both eyes (the unaffected eye must be covered to prevent movement of the affected eye). If the object is small, use eye patches or sterile dressing for both. If the object is large, cover the injured eye with a small cup taped in place and the other eye with an eye patch or sterile dressing. The point is to keep all pressure off the globe of the eye.
– Keep your child (and yourself) as calm and comfortable as possible until help arrives.
What if something penetrated my child’s eye
– Call for emergency medical help.
– Cover both eyes (the unaffected eye must be covered to prevent movement of the affected eye). If the object is small, use eye patches or sterile dressing for both. If the object is large, cover the injured eye with a small cup taped in place and the other eye with an eye patch or sterile dressing. The point is to keep all pressure off the globe of the eye.
– Keep your child (and yourself) as calm and comfortable as possible until help arrives.
What if a chemical entered my child’s eyes
– Many chemicals, even those found around the house, can damage an eye. If your child gets a chemical in the eye and you know what it is, look on the product’s container for an emergency number to call for instructions.
– Flush the eye (see above) with lukewarm water for 15 to 30 minutes. If both eyes are affected, do it in the shower.
– Call for emergency medical help.
– Call your local poison control center for specific instructions. Be prepared to give the exact name of the chemical (if you have it).
– Cover both eyes with sterile dressings, and keep them covered until help arrives.
What to do if my child get a black eye
A black eye is often a minor injury, but it can also appear when there is significant eye injury or head trauma. A visit to your doctor or an eye specialist may be required to rule out serious injury, particularly if you’re not certain of the cause of the black eye.
For a “simple” black eye:
– Apply cold compresses intermittently: five minutes to 10 minutes on, 10 minutes to 15 minutes off. If you are not at home when the injury occurs and there is no ice available, a cold soda will do to start. If you use ice, make sure it is covered with a towel or sock to protect the delicate skin on the eyelid.
– Use cold compresses for 24 to 48 hours, then switch to applying warm compresses intermittently. This will help the body reabsorb the leakage of blood and may help reduce discoloration.
– If the child is in pain, give acetaminophen? Not aspirin or ibuprofen, which can increase bleeding.
– Prop the child’s head with an extra pillow at night, and encourage her to sleep on the uninjured side of her face (pressure can increase swelling).
– Call your doctor, who may recommend an in-depth evaluation to rule out damage to the eye. Call immediately if any of the following symptoms appear:
* increased redness
* drainage from the eye
* persistent eye pain
* distorted vision
* any visible abnormality of the eyeball
If the injury occurred during one of your child’s routine activities such as a sport, follow up by investing in an ounce of prevention – protective goggles or unbreakable glasses are vitally important.
What if my child needs to wear glasses
Shortly after birth, your baby’s eyes should be examined for vision problems and signs of disease. An infant’s eyes can be checked by an ophthalmologist through a dilated pupil even though the tiny patient is too young to give verbal responses to testing. Remember, the earlier any potential problem is detected, the earlier it can be corrected.
If your child needs glasses, there are several factors to consider when purchasing them.
Get the Best Lenses
For most children, the ideal lens is made of polycarbonate. It’s strong, lightweight and shatterproof, safety factors for active toddlers and budding athletes. Polycarbonate does scratch easily, so a scratch-resistant coating is usually a good idea.
Find the Right Frames and a Good Fit
The lens prescription will frequently influence what sort of frame you should choose for your child’s glasses; certain kinds of frames work poorly with certain kinds of lenses. Your Eye M.D. will explain the options. When possible, purchase glasses from a pediatric ophthalmologist, and be sure to investigate the various devices available to ensure a proper fit:
– Silicone nose pads with non-skid surfaces will prevent frames from slipping.
– Comfort cables secure children’s glasses by wrapping around their ears. Comfort cable temples are available for frame sizes worn by infants one to four years old.
– Flexible hinges bend outward, useful for a child who pulls the temples away from their head when removing their glasses.
– Straps may be needed to replace ear pieces in babies. Infants wearing straps are able to roll or lay on their side without discomfort or dislodging the glasses.
– Shop for your child the way you would for yourself? try to match the frame style to the child’s facial shape and features. The more a kid likes their glasses, the more care they may take with them.
Selling Your Child on Glasses
If the child is old enough, let him or her choose the frames. Say nice things about your child’s new glasses, and talk to siblings beforehand to keep teasing to a minimum. Some infants will simply refuse to wear the glasses and pull them off. Don’t fight it, just be persistent. Put the glasses on the baby and then stage some sort of distraction. If the baby pulls them off again, set them aside and wait awhile before trying again.
If you have questions about the fit of the glasses, take your child back to the Eye doctor If your child continues to remove the glasses, talk to your doctor for further help.
If your child has a red eye, he needs to see the pediatrician as soon as possible. The doctor will make the diagnosis, prescribe the necessary medication, and show you how to cleanse the eyelids. Never put previously opened medication or someone else’s eye medication into your child’s eye. It could cause serious damage. In the newborn baby, serious eye infections may result from exposure to bacteria during passage through the birth canal, which is why all infants are treated with antibiotic eye ointment or drops in the delivery room.
Such infections must be treated early to prevent serious complications. Eye infections that occur after the newborn period may be unsightly, because of the redness of the eye and the yellow discharge that usually accompanies them, and they may make your child uncomfortable, but they are rarely serious.
Several different viruses, or occasionally bacteria, may cause them, and topical antibiotics (eyedrops prescribed by your pediatrician) are the usual treatment. Eye infections typically last up to one week and may be contagious. Except to administer drops or ointment, you should avoid direct contact with your child’s eyes or drainage from them until the medication has been used for several days and there is evidence of clearing of the redness.
Carefully wash your hands before and after touching the area around the infected eye. If your child is in a day-care or nursery-school program, you should keep him home until the eyes are no longer red.
If the white of your child’s eye and the inside of his lower lid become red, he probably has a condition called conjunctivitis.
Also known as “pink eye” or “red eye,” this inflammation usually signals an infection but may be due to other causes, such as an irritation, an allergic reaction or (rarely) a more serious illness.
It’s often accompanied by tearing and discharge, which is the body’s way of trying to heal or remedy the situation.
Your Eye M.D. (ophthalmologists) recommends the following schedule for eye examinations:
(Age at which screening for eye disease by a pediatrician, nurse or trained screener should take place)
- Once between age newborn to 3 months
- Once between age 6 months to 1 year
- Once at age 3 years (approximately)
- Once at age 5 years (approximately)
(Comprehensive medical eye exam by an Eye M.D., ophthalmologist)
- Once between age 20 and 39
- Every two to four years between age 40 to 64
- Every one to two years for persons age 65 and older
- Some factors may put your child, or yourself, at increased risk for eye disease. If any of these factors applies to you or your child, check with your Eye M.D. (ophthalmologist) to see how often you should have a medical eye exam:
– Developmental delay
– Premature birth
– Personal or family history of eye disease
– Dark skin individuals
– Previous serious eye injury
– Use of certain medications (check with your Eye M.D)
– Some diseases that affect the whole body (such as diabetes or HIV infection
Sometimes infants appear to have crossed eyes, yet the eyes are truly straight. The cause for pseudostrabismus is presence of a wide nasal bridge or extra folds of skin between the nose and the inside of the eye that make the child have a cross-eyed appearance. Most children outgrow this problem, but you should contact your doctor for an examination. Your pediatrician can tell whether a child has misaligned eyes or just pseudostrabismus, but in some instances, a visit to an ophthalmologist is necessary for further tests.
Treatment for strabismus is similar to amblyopia treatment: vision therapy including patching or visual exercises, glasses with the correct prescription or bifocal or prism correction to aid in proper focusing, eyedrops to help focus, or surgery. Surgery will correct the misaligned eyes but cannot resolve amblyopia caused by strabismus.
Before scheduling a child for surgery, the doctor might inject the ocular muscles with Botox (botulinum), which temporarily relaxes the muscles. In some cases, strabismus is permanently corrected in this way.
Strabismus may be caused by unequal pulling of muscles on one side of the eye or a paralysis of the ocular muscles. Occasionally, when a farsighted child tries to focus to compensate for the farsightedness, he or she will develop accommodative strabismus. This condition usually appears before two years of age, and can occur as late as six.
Strabismus is a condition where your eyes don’t look toward the same object together. One eye moves normally, while the other points in (esotropia or “crossed eyes”), out (exotropia), up (hypertropia) or down (hypotropia). Strabismus can lead to amblyopia. Strabismus is the physical disorder, and amblyopia is the visual consequence.
Strabismus is a condition where your eyes don’t look toward the same object together. One eye moves normally, while the other points in (esotropia or “crossed eyes”), out (exotropia), up (hypertropia) or down (hypotropia). Strabismus can lead to amblyopia. Strabismus is the physical disorder, and amblyopia is the visual consequence.
Amblyopic children can be treated with vision therapy (which often includes patching one eye), atropine eye drops, the correct prescription for nearsightedness or farsightedness, or surgery.
Vision therapy exercises the eyes and helps both eyes work as a team. Vision therapy for someone with amblyopia forces the brain to see through the amblyopic eye, thus restoring vision.
Sometimes the eye doctor or vision therapist will place a patch over the stronger eye to force the weaker eye to learn to see. Patching may be required for several hours each day or even all day long, and may continue for weeks or months.
In some children, atropine eye drops have been used to treat amblyopia instead of patching. One drop is placed in the child’s good eye each day (the parent can do this). Atropine blurs vision in the good eye, which forces the child to use the eye with amblyopia more, to strengthen it. One advantage is that it doesn’t require constant vigilance on the part of the parent to make sure the child wears the patch.
Amblyopia will not go away on its own, and untreated amblyopia can lead to permanent visual problems and poor depth perception. If later in life the child’s stronger eye develops disease or is injured, he or she will be dependent on the poor vision of the amblyopic eye, so it is best to treat amblyopia early on.
Trauma to the eye at any age can cause amblyopia, as well as a strong uncorrected refractive error (nearsightedness or farsightedness) or strabismus. It’s important to correct amblyopia as early as possible, before the brain learns to entirely ignore vision in the affected eye.
Amblyopia generally develops in young children, before age six. Its symptoms often are noted by parents or health-care professionals. If a child squints or completely closes one eye to see, he or she may have amblyopia. Other signs include overall poor visual acuity, eyestrain and headaches.
Untreated amblyopia may lead to functional blindness in the affected eye. Although the amblyopic eye has the capability to see, the brain “turns off” this eye because vision is very blurred. The brain elects to see only with the stronger eye.
Amblyopia, also known as “lazy eye,” is a vision problem that affects just two to three percent of the population, but if left uncorrected, it can have a very big impact on their lives. Central vision does not develop properly, usually in one eye, which is called amblyopic. A related condition, strabismus, sometimes causes amblyopia.
Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.
Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn’t removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).
Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.
Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures.
While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That’s why patients are advised to get frequent dental exams.
In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobial drugs may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and re-contouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.
Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs. If a dentist doesn’t do a periodontal exam during a regular visit, the patient should request it. Children also should be examined.
Tooth decay is the disease known as caries or cavities. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime. Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices.
Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth .
The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body’s natural defense against cavities, saliva alone is not sufficient to combat tooth decay.
The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink.
Fluoride is added to most community water supplies and to many bottled and canned beverages. If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.
Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities.
And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for cavities.
The best way to combat cavities is to follow three simple steps:
1. Cut down on sweets and between-meal snacks. Remember, it’s these sugary and starchy treats that put your teeth at extra risk.
2. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits, the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue.
Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package.
Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child’s developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children.
3. See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.
Tooth sensitivity is caused by the stimulation of cells within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp). When the hard enamel is worn down or gums have receded-causing the tiny tube surfaces to be exposed-pain can be caused by eating or drinking food and beverages that are hot or cold; touching your teeth; or exposing them to cold air. Hot and cold temperature changes cause your teeth to expand and contract.
Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth.
Sensitive teeth is one of the most common complaints among dental patients. At least 45 million adults in the United States and 5 million Canadians, suffer at some time from sensitive teeth.
Some toothpastes contain abrasive ingredients that may be too harsh for people who have sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes may increase tooth sensitivity.
Tooth sensitivity can be reduced by using a desensitizing toothpaste, applying sealants and other desensitizing ionization and filling materials including fluoride by your dentist, and decreasing the intake of acid-containing foods. Tartar control toothpastes will sometimes cause teeth to be sensitive as well as drinking diet soft drinks throughout the day.
Avoid using hard bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth’s root surface and expose sensitive spots. The way to find out if you’re brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you’re brushing too hard.
If a tooth is highly sensitive for more than three or four days, and reacts to hot and cold temperatures, it’s best to get a diagnostic evaluation from your dentist to determine the extent of the problem.
Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that’s not yet visible.
There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since, tooth position and gum condition vary. One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth.
Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.
In general, a toothbrush head should be small (1″ by 1/2″) for easy access. It should have a long, wide handle for a firm grasp. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth.
A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.
It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes, the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they’re brushing longer, but most spend less than a minute brushing. To make sure you’re doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day, instead of brushing quickly five or more times through the day.
Definitely, but most Americans don’t brush during the workday. Yet a recent survey by Oral-B Laboratories and the Academy of General Dentistry shows if you keep a toothbrush at work, the chances you will brush during the day increase by 65 percent. Dentists recommend keeping a toothbrush at work.
Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don’t even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don’t have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.
The following tips may improve your work-time brushing habits: -Post a sticky note on your desk or computer at work as a reminder to brush teeth after lunch. -Brush teeth right after lunch, before you become absorbed in work. -Store your toothbrush and toothpaste at work in a convenient and handy place. -Make brushing your teeth part of your freshening up routine at work.
The ideal time is six months after your child’s first (primary) teeth erupt. This time frame is a perfect opportunity for the dentist to carefully examine the development of your child’s mouth. Because dental problems often start early, the sooner the visit the better. To safeguard against problems such as baby bottle tooth decay, teething irritations, gum disease, and prolonged thumb-sucking, the dentist can provide or recommend special preventive care.
Before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction your child may exhibit-cooperative or non- cooperative. Very young children may be fussy and not sit still. Talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. Bring with you to the appointment any records of your child’s complete medical history.
Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If the child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances.
Short, successive visits are meant to build the child’s trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem. Child appointments should always be scheduled earlier in the day, when your child is alert and fresh. For children under 24-36 months, the parent may need to sit in the dental chair and hold the child during the examination. Also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist. If the child is compliant, the first session often lasts between 15-30 minutes and may include the following, depending on age: -A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas; -If indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar build-up and stains; -X-rays; -A demonstration on proper home cleaning; and, -Assessment of the need for fluoride. The dentist should be able to answer any questions you have and try to make you and your child feel comfortable throughout the visit. The entire dental team and the office should provide a relaxed, non- threatening environment for your child.
1- Protect your baby’s health with fluoride fluoride (said like floor-eyed) protects teeth from tooth decay and helps heal early decay. Fluoride is in the drinking water of some towns and cities. Ask your dentist or doctor if your water has fluoride in it. If it doesn’t, talk to your dentist or doctor about giving you a prescription for fluoride drops for your baby.
2- Check and clean your baby’s teeth. Healthy teeth should be all one color. If you see spots or stains on the teeth, take your baby to your dentist. as soon as they come in with a clean, soft cloth or a baby’s toothbrush. Clean the teeth at least once a day. It’s best to clean them right before bedtime. At about age 2, most of your child’s teeth will be in. Now you can start brushing them with a small drop of fluoride toothpaste.
3- Feed your baby healthy food Choose foods that do not have a lot of sugar in them. Give your child fruits and vegetables instead of candy and cookies.
4- Prevent baby bottle teeth decay Do not put your baby to bed with a bottle at night or at nap time. (If you put your baby to bed with a bottle, fill it only with water). Milk, formula, juices, and other sweet drinks such as soda all have sugar in them. Sucking on a bottle filled with liquids that have sugar in them can cause tooth decay. Decayed teeth can cause pain and can cost a lot to fill. During the day, do not give your baby a bottle filled with sweet drinks to use like a pacifier. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Near his first birthday, you should teach your child to drink from a cup instead of a bottle.
5- Take your child to the dentist. Ask your dentist when to bring your child in for his first visit. Usually, the dentist will want to see a child between ages 1 and 2. At this first visit, your dentist can quickly check your child’s teeth.
Sugary snacks taste so good, but they aren’t so good for your teeth or your body. The candies, cakes, cookies, and other sugary foods that kids love to eat between meals can cause tooth decay. Some sugary foods have a lot of fat in them too. Kids who consume sugary snacks eat many different kinds of sugar every day, including table sugar (sucrose) and corn sweeteners (fructose). Starchy snacks can also break down into sugars once they’re in your mouth.
Invisible germs called bacteria live in your mouth all the time. Some of these bacteria form a sticky material called plaque on the surface of the teeth. When you put sugar in your mouth, the bacteria in the plaque gobble up the sweet stuff and turn it into acids. These acids are powerful enough to dissolve the hard enamel that covers your teeth. That’s how cavities get started. If you don’t eat much sugar, the bacteria can’t produce as much of the acid that eats away enamel.
Before your baby starts munching on a snack, ask yourself what’s in the food you’ve chosen. Is it loaded with sugar? If it is, think again. Another choice would be better for his/her teeth. And keep in mind that certain kinds of sweets can do more damage than others. Gooey or chewy sweets spend more time sticking to the surface of his/her teeth. Because sticky snacks stay in their mouth longer than foods that you quickly chew and swallow, they give teeth a longer sugar bath. You should also think about when and how often to eat snacks. Do they nibble on sugary snacks many times throughout the day, or do they usually just have dessert after dinner? Damaging acids form in their mouth every time they eat a sugary snack. The acids continue to affect their teeth for at least 20 minutes before they are neutralized and can’t do any more harm. So, the more times they eat sugary snacks during the day, the more often they feed bacteria the fuel they need to cause tooth decay. If they eat sweets, it’s best to eat them as dessert after a main meal instead of several times a day between meals. Whenever they eat sweets, in any meal or snack, they should brush their teeth well with a fluoride toothpaste afterward. When you’re deciding about snacks, think about: -The number of times a day they eat sugary snacks -How long the sugary food stays in the mouth -The texture of the sugary food (chewy? sticky?) If they snack after school, before bedtime, or other times during the day, they should pick something without a lot of sugar or fat. There are lots of tasty, filling snacks that are less harmful to their teeth — and the rest of their body — than foods loaded with sugars and low in nutritional value. Snack smart!
Whenever a sore throat is severe, persists longer than the usual five- to seven- day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician: -Severe and prolonged sore throat -Difficulty breathing -Difficulty swallowing -Difficulty opening the mouth -Joint pain -Earache – Rash -Fever (over 101?) -Blood in saliva or phlegm -Frequently recurring sore throat -Lump in neck -Hoarseness lasting over two weeks
Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or haemophilus. While bacteria respond to antibiotic treatment, viruses do not. Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains. These viruses are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week. Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful. One viral infection takes much longer than a week to be cured: infectious mononucleosis, or “mono.” This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface and swollen glands in the neck, armpits, and groin. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice? yellow skin and eyes. It also causes extreme fatigue that can last six weeks or more. “Mono,” a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the “kissing disease,” but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils. Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests. Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues “catch” infections, sampling the child’s environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed. Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it. The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection. Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them. Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose. Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods. A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes. Reflux: An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bed frame so that the head is elevated four- to six-inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor. Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing, sometimes with pain radiating to the ear, may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.
Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed. It is possible for the duct system of the major salivary glands that connects the glands to the mouth to be abnormal. These ducts can develop small constrictions, which decrease salivary flow, leading to infection and obstructive symptoms. Infection: The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can occur in adults. However, if an adult has swelling in the area of the parotid gland only on one side, it is more likely due to an obstruction or a tumor. Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria. You may have a secondary infection of salivary glands from nearby lymph nodes. These lymph nodes are the structures in the upper neck that often become tender during a common sore throat. In fact, many of these lymph nodes are actually located on, within, and deep in the substance of the parotid gland or near the submandibular glands. When these lymph nodes enlarge through infection, you may have a red, painful swelling in the area of the parotid or submandibular glands. Lymph nodes also enlarge due to tumors and inflammation. Tumors: Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips. An otolaryngologist-head and neck surgeon should check these enlargements. Malignant tumors of the major salivary glands can grow quickly, may be painful, and can cause loss of movement of part or all of the affected side of the face. These symptoms should be immediately investigated. Other Disorders: Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjogren’s syndrome where the body’s immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides.
Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids. Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons: ? Uvulopalatopharyngoplasty (UPPP) is a surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages. ? Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radio-frequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures in a doctor’s office under local anesthesia. Radio-frequency ablation?some with temperature control approved by the FDA?utilizes a needle electrode to emit energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction). ? Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway. Self-Help for the Light Snorer Adults who suffer from mild or occasional snoring should try the following self-help remedies: ? Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight. ? Avoid tranquilizers, sleeping pills, and antihistamines before bedtime. ? Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring. ? Establish regular sleeping patterns ? Sleep on your side rather than your back. ? Tilt the head of your bed upwards four inches. Remember, snoring means obstructed breathing, and obstruction can be serious. It’s not funny, and not hopeless.
Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer’s health.
When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder. The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.
Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness. Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.
The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing. People who snore may suffer from: ? Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep. ? Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare. ? Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse. ? Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.
Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.
Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.
The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist–head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.
Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.
To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies.
Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also helpful in moisturizing nasal passages.
Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.
Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.
For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough. Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.
Millions around the world suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.
Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the para-nasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.
Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. If the doctor diagnoses your case early, it will probably respond to these simple, self-remedies: ? Rest the muscles and joints by eating soft foods. ? Do not chew gum. ? Avoid clenching or tensing. ? Relax muscles with moist heat (1/2 hour at least twice daily). In cases of joint injury, ice packs applied soon after the injury can help reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose your doctor recommends. Other therapies may include fabrication of an occlusal splint to prevent wear and tear on the joint. Improving the alignment of the upper and lower teeth and surgical options are available for advanced cases. After diagnosis, your otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.
In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness. Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench, grit, or grind your teeth, you increase the wear on the cartilage lining of the joint, and it doesn’t have a chance to recover. Many persons are unaware that they grind their teeth, unless someone tells them so. Chewing gum much of the day can cause similar problems. Stress and other psychological factors have also been implicated as contributory factors to TMJ dysfunction. Other causes include teeth that do not fit together properly (improper bite), mal-positioned jaws, and arthritis. In certain cases, chronic mal-position of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.
The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth. A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction. There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.
When you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction. Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.
You may not have heard of it, but you use it hundreds of times every day. It is the Temporo-Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily; each time you chew you move it. But you also move it every time you talk and each time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all joints of the body and one of the most complex. You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal. These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and physicians use these maneuvers with patients for diagnosis.
The results of diagnostic testing will determine treatment. ? If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses like Ramsay Hunt) may be used. ? If simple swelling is believed to be responsible for the facial nerve disorder, then steroids are often prescribed. ? In certain circumstances, surgical removal of the bone around the nerve (decompression) may be appropriate.
The most common cause of facial weakness which comes on suddenly is referred to as “Bell’s palsy.” This disorder is probably due to the body’s response to a virus: in reaction to the virus the facial nerve within the ear (temporal) bone swells, and this pressure on the nerve in the bony canal damages it. In order to be sure that this is the cause of the facial weakness, and not something else, a special set of questions will be asked. After an examination of the head, neck, and ears, a series of tests may be performed. The most common tests are: ? Hearing Test: Determines if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism. ? Balance Test: Evaluates balance nerve involvement. ? Tear Test: Measures the eye’s ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye cornea). ? Imaging: CT (computerized tomography) or MRI (magnetic resonance imaging) determines if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve. ? Electrical Test: Stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.
The facial nerve resembles a telephone cable and contains 7,000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, “the nerve of facial expression”. When half or more of these individual nerve fibers are interrupted, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in twitching, weakness, or paralysis of the face, in dryness of the eye or the mouth, or in disturbance of taste.
Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils). – Increased thick secretions in the winter often result from too little moisture in heated buildings and homes. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose (such as a bean, wadded paper, or piece of toy, etc.). – Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral “cold” that persists for 10 days or more may have become a bacterial sinus infection. With this infection you may notice increased post-nasal drip. If you suspect that you have a sinus infection, you should see your physician for antibiotic treatment. – Chronic sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an exam of the interior of the nose with a non-allergic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended. – Vasomotor rhinitis describes a non-allergic “hyperirritable nose” that feels congested, blocked, or wet. – Swallowing Problems Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerve and muscle interaction in the mouth, throat, and food passage (esophagus) aren’t working properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi) causing hoarseness, throat clearing, or cough. Several factors contribute to swallowing problems: ? With age, swallowing muscles often lose strength and coordination. Thus, even normal secretions may not pass smoothly into the stomach. ? During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed when awakening. ? When nervous or under stress, throat muscles can trigger spasms that feel like a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation. ? Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids. Swallowing problems may be caused also by gastroesophageal reflux disease (GERD). This is a return of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux. Chronic Sore Throat: Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.
The glands in your nose and throat continually produce mucus (one to two quarts a day). It moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This feeling can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.
Many physicians suggest any of the following lubricating creams or ointments. They can all be purchased without a prescription: Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline. Up to three applications a day may be needed, but usually every night at bedtime is enough. A saline nasal spray will also moisten dry nasal membranes. If the nosebleeds persist, you should see your doctor. Using an endoscope, a tube with a light for seeing inside the nose, your physician may find a problem within the nose that can be fixed. He or she may recommend cauterization (sealing) of the blood vessel that is causing the trouble.
If you or your child has an anterior nosebleed, do the following steps: – Help the patient stay calm, espicially a young child. A person who is agitated may bleed more profusely. – Pinch all the soft parts of the nose between your thumb and the side of your index finger. Or soak a cotton ball with Afrin and insert it into the nostril. – Press firmly but gently toward the face compressing the pinched parts of the nose against the bones of the face. – Hold that position for full 5 minutes by the clock. – Keep the head higher than level of the heart. Sit up or lie back a little with the head elevated. – Apply ice-crushed in a plastic bag or washcloth to nose and cheeks .
Obviously, when the patient is lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow posteriorly, especially if the patient is coughing or blowing his nose. It is important to try to make the distinction since posterior (back of nasal cavity) nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face. Anterior nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented if you place a bit of lubricating cream or ointment about the size of a pea on the end of your fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).
Most nosebleeds begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood out one nostril when the patient is sitting or standing.
Most nosebleeds (epistaxis) are mere nuisances. But some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two different types.
Cochlear implants do not restore normal hearing, and benefits vary from one individual to another. Most users find that cochlear implants help them communicate better through improved lip-reading, and over half are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including: – How long a person has been deaf -The number of surviving auditory nerve fibers, and a patient’s motivation to learn to hear. Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. A few patients do not benefit from implants.
About one month after surgery, your team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant. Some implants take longer to fit and require more training. Your team will probably ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.
Implant surgery is performed under general anesthesia and lasts from two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure may be done as an outpatient, or may require a stay in the hospital, overnight or for several days, depending on the device used and the anatomy of the inner ear.
Implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be two years of age or older (unless childhood meningitis is responsible for deafness). Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, though not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The evaluation will be done by an implant team (an otolaryngologist, audiologist, nurse, and others) that will give you a series of tests: Ear (otological) evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormality precludes the implant surgery. Hearing (audiological) evaluation: The audiologist performs an extensive hearing test to find out how much you can hear with and without a hearing aid. ? X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear bone. ? Psychological evaluation: Some patients may need a psychological evaluation to learn if they can cope with the implant. ? Physical examination: Your otolaryngologist also gives a physical examination to identify any potential problems with the general anesthesia needed for the implant procedure.
Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve. The implant consists of a small electronic device, which is surgically implanted under the skin behind the ear and an external speech processor, which is usually worn on a belt or in a pocket. A microphone is also worn outside the body as a headpiece behind the ear to capture incoming sound. The speech processor translates the sound into distictive electrical signals. These ‘codes’ travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The electrodes’ signals stimulate the auditory nerve fibers to send information to the brain where it is interpreted as meaningful sound.
If you have disease or obstruction in your external or middle ear, your conductive hearing may be impaired. Medical or surgical treatment can probably correct this. An inner ear problem, however, can result in a sensorineural impairment or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. Since severe sensorineural hearing loss cannot be corrected with medicine, it can be treated only with a cochlear implant.
Your ear consists of three parts that play a vital role in hearing, the external ear, middle ear, and inner ear. ? Conductive hearing: Sound travels along the ear canal of the external ear causing the ear drum to vibrate. Three small bones of the middle ear conduct this vibration from the ear drum to the cochlea (auditory chamber) of the inner ear. ? Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells). As these hair cells move, they generate an electrical current in the auditory nerve. It travels through inter-connections to the brain area that recognizes it as sound.
A cochlear implant is an electronic device that restores partial hearing to the deaf. It is surgically implanted in the inner ear and activated by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing impaired to receive sound.
Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients. Masking. Tinnitus is usually more bothersome in quiet surroundings. A competing sound at a constant low level, such as a ticking clock or radio static (white noise), may mask the tinnitus and make it less noticeable. Products that generate white noise are also available through catalogs and specialty stores. Hearing Aids. If you have a hearing loss, a hearing aid(s) may reduce head noise while you are wearing it and sometimes cause it to go away temporarily. It is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus. Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.
In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise, but this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help. The following list of DOs and DON’Ts can help lessen the severity of tinnitus: – Avoid exposure to loud sounds and noises. -Get your blood pressure checked. If it is high, get your doctor’s help to control it. – Decrease your intake of salt. Salt impairs blood circulation. – Avoid stimulants such as coffee, tea, cola, and tobacco. – Exercise daily to improve your circulation. – Get adequate rest and avoid fatigue. – Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible.
Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called “objective tinnitus,” and it caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms, which may sound like clicks or crackling inside the middle ear.
Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well. There are many causes for “subjective tinnitus,” the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis). Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatorie drugs, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size.
Not at all. Tinnitus is the name for these head noises, and they are very common. Nearly 36 million Americans suffer from this discomfort. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant, it can be annoying and distracting. More than seven million people are afflicted so severely that they cannot lead normal lives.
Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures. If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it will dose spontaneously. They also might try to patch a cooperative patient’s ear-drum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually, with closure of the tympanic membrane, improvement in hearing is noted. Several applications of a patch (up to three or four) may be required before the perforation doses completely. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered. There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in closing the perforation permanently, and improving hearing. It is usually done on an outpatient basis. Your doctor will advise you regarding the proper management of a perforated eardrum.
Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g., skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing maybe quite severe. If the perforated eardrum is due to a sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause major hearing loss.
The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur: If the ear is struck squarely with an open hand, with a skull fracture, after a sudden explosion, if an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal. As a result of hot slag (from welding) or acid entering the ear canal Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the ear-drum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician. Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery.
A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.
Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal. So when a patient has wax blocked up against the eardrum, it is often because he has been probing his ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper. Also, the skin of the ear canal and the eardrum is very thin and fragile and is easily injured. Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out. Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn’t always so. If you want to clean your ears, you can wash the external ear with a cloth over a finger, but do not insert anything into the ear canal.
The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear. Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing. The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections. Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.
In infants and toddlers look for: pulling or scratching at the ear, especially if accompanied by the following… 1. hearing problems 2. crying, irritability 3. fever 4. vomiting 5. ear drainage In young children, adolescents, and adults look for: earache, feeling of fullness or pressure, hearing problems, dizziness, loss of balance, nausea, vomiting, ear drainage, fever Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.
Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems. Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.
Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal. Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor. The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance. A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.
Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.
An examination by an otolaryngologist, head and neck surgeon, can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma. Admission to the hospital is usually done the morning of surgery, and if the surgery is performed early in the morning, discharge maybe the same day. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks. Follow-up office visits after surgical treatment are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.
Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.
Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort). Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation.
A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.
A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.
Always ride where your eyes will see the same motion that your body and inner ears feel, e.g., sit in the front seat of the car and look at the distant scenery; go up on the deck of the ship and watch the horizon; sit by the window of the airplane and look outside. In an airplane choose a seat over the wings where the motion is the least. Do not read while traveling if you are subject to motion sickness, and do not sit in a seat facing backward. Do not watch or talk to another traveler who is having motion sickness. Avoid strong odors and spicy or greasy foods immediately before and during your travel. Medical research has not yet investigated the effectiveness of popular folk remedies such as soda crackers and & Seven Up, or cola syrup over ice. Take one of the varieties of motion sickness medicines before your travel begins, as recommended by your physician. Some of these medications can be purchased without a prescription (i.e., Dramamine?, Bonine?, Marezine?, etc.) Stronger medicines such as tranquilizers and nervous system depressants will require a prescription from your physician. Some are used in pill or suppository form.
Avoid rapid changes in position, especially from lying down to standing up or turning around from one side to the other. Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting). Eliminate or decrease use of products that impair circulation, e.g., nicotine, caffeine, and salt. Minimize your exposure to circumstances that precipitate your dizziness, such as stress and anxiety or substances to which you are allergic. Avoid hazardous activities when you are dizzy, such as driving an automobile or operating dangerous equipment, or climbing a step ladder, etc.
Circulation: If your brain does not get enough blood flow, you feel light headed. Almost everyone has experienced this on occasion when standing up quickly from a lying down position. But some people feel light headed from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function or with anemia. Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension. If the inner ear falls to receive enough blood flow, the more specific type of dizziness occurs-that is-vertigo. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear. Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks, then slowly improve as the normal (other) side takes over Infection: Viruses, such as those causing the common “cold” or “flu,” can attack the inner ear and its nerve connections to the brain. This can result in severe vertigo, but hearing is usually spared. However, a bacterial infection such as mastoiditis that extends into the inner ear will completely destroy both the hearing and the equilibrium function of that ear. The severity of dizziness and recovery time will be similar to that of skull fracture. Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, danders, etc.) to which they are allergic. Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your physician will think about them during the examination.
The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems. For example, suppose you are riding through a storm, and your airplane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Then your brain receives messages that do not match with each other. You might become “air sick.” Or suppose you are sitting in the back seat of a moving car reading a book. Your inner ears and skin receptors will detect the motion of your travel, but your eyes see only the pages of your book. You could become “car sick.” Or, to use a true medical condition as an example, suppose you suffer inner ear damage on only one side from a head injury or an infection. The damaged inner ear does not send the same signals as the healthy ear. This gives conflicting signals to the brain about the sensation of rotation, and you could suffer a sense of spinning, vertigo, and nausea.
Some people experience nausea and even vomiting when riding in an airplane, automobile, or amusement park ride, and this is called motion sickness. Many people experience motion sickness when riding on a boat or ship, and this is called seasickness even though it is the same disorder. Motion sickness or seasickness is usually just a minor annoyance and does not signify any serious medical illness, but some travelers are incapacitated by it, and a few even suffer symptoms for a few days after the trip.
A few people describe their balance problem by using the word vertigo, which comes from the Latin verb “to turn”. They often say that they or their surroundings are turning or spinning. Vertigo is frequently due to an inner ear problem.
Some people describe a balance problem by saying they feel dizzy, lightheaded, unsteady, or giddy. This feeling of imbalance or disequilibrium, without a sensation of turning or spinning, is sometimes due to an inner ear problem.
A number of medications are useful in the treatment of allergy including antihistamines, decongestants, cromolyn, and cortisone-type preparations. The medical management of allergy also includes counseling in proper environmental control. Based on a detailed history and thorough examination, your doctor may advise testing to determine the specific substances to which you are allergic. The methods employed by your otolaryngologists will indicate the materials to which you are allergic, and the degree of your sensitivity to them. The only “cure” available for inhalant allergy is the administration of injections that build up protective antibodies to specific allergens (pollens, molds, animal danders, dust, etc.). Your physician will oversee your progress throughout the course of treatment and care for any other nasal and sinus disorders that may contribute to your symptoms.
Allergic patients show reduced resistance to respiratory infections, and more severe symptoms when infections occur. Allergies are rarely life threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the enjoyment of life. Considering the millions spent in anti-allergy medications and the cost of lost work time, allergies cannot be considered a minor problem.
Hay fever is caused by pollens. Certain allergens are always present. These include house dust, household pet danders, foods, wool, various chemicals used around the house, and more. Symptoms from these are frequently worse in the winter when the house is closed up. Mold spores cause at least as many allergy problems as pollens. Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Molds are also common in foods, such as cheese.
Hay fever describes the symptoms of runny nose, itchy eyes and throat, uncontrollable sneezing and sometimes itching of the skin. It is not caused by hay, and does not produce fever. The correct name for the condition is seasonal allergic rhinitis. Many seasonal “colds” are actually allergic rhinitis and will not respond to antibiotics. Seasonal allergic rhinitis happens when pollens and/or particles of plant or animal dander, mold spores, etc., come into contact with the lining of the nose, eyes, or throat. The body’s immune system recognizes their presence and starts a reaction to prevent their invasion.
In most people this is not a problem. However, in some patients the immune system is overactive and identifies normally harmless particles as dangerous, producing an excessive reaction that actually causes inflammation. This is known as allergy and the substances causing it are allergens. People are allergic to only certain substances, and the reaction does not usually appear until after several exposures to that substance.