Conventional Myringotomy and Grommet insertion

Laser Myringotomy(OTOLAM)

Procedure

The increased risk of a tumor of the auditory nerve, called an acoustic neuroma, was found to be about four times higher on the side of the head where the phone was held, and virtually normal on the other side.
Approximately one in 100,000 people develop acoustic neuromas. This type of tumor grows slowly and accounts for less than 10 percent of all brain tumors. Because these tumors do not involve invasive growth, they are not classified as cancer.
Hand-held wireless phones with built-in antennas, known as mobile phones, or cell phones, emit low levels of radiofrequency energy in the microwave range while being used. The auditory nerve is exposed to radiation during the normal use of a cell phone.

Researchers who have raised concerns say that just because science can’t explain the mechanism doesn’t mean one doesn’t exist. Concerns have focused on the heat (microwave) generated by cell phones and the fact that the radio frequencies are absorbed mostly by the head and neck.
The real concern is not older cell phone users, who began using phones as adults, but children who are beginning to use phones today and face a lifetime of exposure.

For people who are concerned about any possible risk, a simple solution is to use a headset. Of course, that option isn’t always convenient, and some critics have raised worries about wireless devices like the Bluetooth that essentially place a transmitter in the ear.

The fear is that even if the individual risk of using a cell phone is low, with three billion users worldwide, even a minuscule risk would translate into a major public health concern.
No one can say with any certainty that cell phones are either safe or not safe The main concern is that with the widespread use of cell phones, the worst scenario would be that we may get the definitive study 10 or 15 years from now, and we find out there is a correlation. And then it will be too late.
So be careful.

Down syndrome is a chromosomal abnormality caused by an additional (third) chromosome 21 or “trisomy 21.” Down syndrome is associated with mental retardation, a characteristic facial appearance, and poor muscle tone (hypotonia).
This occurs in approximately 1 in every 900 births. Down syndrome is not inherited; it does not “run in families.”

John Langdon Down, while working as the superintendent of the Earlswood Asylum for mentaly retarded, published the first clinical description of the syndrome around 140 years ago.

Some people with Down’s syndrome experience very few health problems as a result of their condition. However, others can be more severely affected and require extra medical care and attention.

Hearing problems

Approximately 50% of people with Down’s syndrome experience problems with their ears - hearing, more of a conductive hearing loss because of the accumulation of fluid in the middle ear.
Glue ear is a common condition for people with Down’s syndrome. It is caused by a build up of fluid in the middle ear. In some cases, the fluid thickens, making sounds appear muffled and distorted.
If your child cannot hear clearly, this may mean they find it more difficult to learn, or to interact with other children.
The reason for having glue ear is because these children have narrow and short Eustachian tube.
The external auditory canal makes any surgical procedure difficult.

The treatment is myringotomy, aspiration of glue (thick secretion) with or with out grommet insertion.
Some advocates not putting grommet as the side effects of keeping the grommet in situ.
Adenoid if enlarged can be removed same time.
The grommet is left in situ until it extrudes by itself. Avoid water getting in the ear while bathing and swimming.

Insects in the Ear
Insects may fly into the ear and become trapped causing great discomfort and pain. Sometimes, the insect dies after entering the ear; other times, it may remain alive and attempt to work its way back out of the ear. In either case, the insect should be removed immediately.
What to do in an emergency situation?
If you think the insect is still alive and it does not come out with gentle head shaking, pour a small amount of vegetable or baby oil into the ear canal. This will usually suffocate and immobilize the insect. If you think the insect is dead and it does not come out with gentle head shaking, pour a small amount of warm water into the ear canal to flush it out.
Do not attempt to remove the insect by poking it with a cotton swab or similar probe. This may push the insect farther into the ear or cause damage to the middle ear and eardrum.

Consult an Ear Specialist

Insects are able to cause damage to the inside of the ear by stinging or scratching the eardrum.
The ear should be examined under a microscope and any damage if done is assessed and treated accordingly.
Antibiotic ear drops, analgesics, antibiotic may be prescribed.

Fever is any body temperature above 100°F (37.8°C).A healthy person’s body temperature fluctuates between 97°F (36.1°C) and 100°F (37.8°C), with the average being 98.6°F (37°C).
Fever occurs when the body’s internal thermostat raises the body temperature above its normal level. This thermostat is found in the hypothalamus, a part of brain. The nervous system constantly relays information about the body’s temperature to the thermostat, which in turn activates different physical responses designed to cool or warm the body, depending on the circumstances.
A fever occurs when the thermostat resets at a higher temperature, primarily in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering.
Shivering generates heat through muscle contraction; and inducing sweating, which cools the body through evaporation. The chills that often accompany a fever are caused by the movement of blood to the body’s core, leaving the surface and extremities cold. Once the higher temperature is achieved, the shivering and chills stop.

Symptoms

A fever occurs when your temperature rises above its normal range. What’s normal for you may be a little higher or lower than the average temperature of 98.6 F. But a rectal temperature higher than 100.4 F is always considered a fever. A rectal temperature reading is generally 1 degree Fahrenheit higher than an oral reading.
Depending on what’s causing your fever, additional fever symptoms may include: Sweating, shivering, headache, muscle aches, lack of appetite, dehydration and general weakness
Very high fevers, between 103 and 106 F, may cause: Hallucinations, confusion, irritability and convulsions

Febrile seizures
About 4 percent of children younger than age 5 experience fever-induced seizures, febrile seizures. The signs of febrile seizures, which occur when a child’s temperature rises or falls rapidly, include a brief loss of consciousness and convulsions.

Treating fever

• You can give acetaminophen or ibuprofen. Never give aspirin to a child due to its association with Reye syndrome, a rare but potentially fatal disease.
• Giving a sponge bath help bring the fever down.
• Offer plenty of fluids to avoid dehydration- a fever will cause the patient to lose fluids more rapidly. Water, soup, ice pops, and flavored gelatin are all good choices. Avoid drinks containing caffeine, including colas and tea, because they can cause increased urination.
• Make sure you get plenty of rest.

Eosinophils are white blood cells. Eosinophils are produced in the bone marrow and are normally found in the bloodstream and the gut lining. They contain proteins that help the body to fight infection from parasitic organisms, such as worms.

What is eosinophilia?

The term eosinophilia refers to conditions in which abnormally high amounts of eosinophils are found in either the blood or in body tissues. More than 500 eosinophils per cubic millimetre of blood are abnormal, and are called eosinophilia; this number usually amounts to more than 8% of all white cells.
In general eosinophilia arises as a response to parasites (such as filaria or helminths), or from allergy as occurs with asthma and allergic rhinitis, or in some gastrointestinal disorders that may be associated with food allergy.
A few drugs or inhaled allergens can cause inflammatory tissue changes accompanied by eosinophilia in susceptible people.

How does eosinophilia occur?

Increased numbers of eosinophils are produced to fight off allergic disease or parasitic infections. This is helpful in combating parasitic infections but not in cases of allergic diseases as they accumulate in tissues and cause damage. For example, in asthma, eosinophilia causes damage to the airways of the lung.

What are the symptoms of eosinophilia?

The symptoms of eosinophilia are those of the underlying condition. For example, eosinophilia due to asthma is marked by symptoms such as wheezing and breathlessness, whereas parasitic infections may lead to abdominal pain, diarrhea, fever, or cough and rashes.
Sneezing and nasal symptoms are common.

Medicine reactions often give rise to skin rashes, and they often occur after taking a new drug.

Rarer symptoms of eosinophilia can include weight loss, night sweats, lymph node enlargement, other skin rashes, and numbness and tingling due to nerve damage.

In India

In tropical countries like India, parasites are a common cause of eosinophilia, and there is often an association with asthma and allergic rhinitis.
Hypereosinophilic syndrome

Hypereosinophilic syndrome is a condition where there is no apparent cause for eosinophilia. In idiopathic hypereosinophilic syndrome occurs, with an eosinophil count in excess of 1500 cells per cubic millimeter of blood, and the heart or nervous system may be affected.

How is eosinophilia diagnosed?

Eosinophilia in the bloodstream is diagnosed from a simple blood test. Tissue eosinophilia is diagnosed by the examination of the relevant tissue.. Further tests may include blood tests to measure levels of antibodies, chest X-ray, CT scans of the chest and abdomen, skin or lung biopsies, examination of the bone marrow, and bronchoscopy.

Specific treatment for a parasite would necessitate first identifying the cause from a stool specimen, or from a blood specimen taken if there is fever.
If no abnormalities are found on a thorough physical exam, then no other tests may be indicated, although sometimes a biopsy of an involved organ may be appropriate. When there is evidence of skin allergy or asthma, it is usually necessary to use drug therapy.

Treatment

The first line of treatment would be antihistamines. The next to be considered would be oral corticosteroids. For predominant asthma, a trial for several weeks of an inhaled steroid would be appropriate along with an inhaled bronchodilator like ventolin.

Diethylcarbamazine
100 mg three times a day for 2-3 weeks. It is better to start the treatment after giving Albendazole/Zentel to get rid of any intestinal parasites.

Tropical eosinophilia

TPE is an immune hyperresponse to filarial infection. The syndrome includes a high eosinophil count, pulmonary symptoms and radiological changes, fever, dyspnea, and loss of weight.
Tropical pulmonary eosinophilia is reported from southern India, Sri Lanka, Malaysia, and Southeast Asia , caused by filarial parasites.