Diagnosing Tonsils and Adenoid

Examination of the tonsils by looking in the back of your child’s mouth using a light and mirror or a flexible telescope.
Your doctor may recommend a tonsillectomy if your child suffers from frequent bouts of tonsillitis or ear infections, or has breathing problems caused by swollen tonsils.
Xray of the Postnasal space shows enlarged adenoid.

Preop preparation

A tonsillectomy usually requires an overnight stay in hospital. If your child has a cold or infection in the week before the operation, please let your doctor know about it. The operation may need to be postponed until your child has fully recovered.
The operation is done under general anaesthesia. This means your child will be asleep during the procedure. Typically, your child must not eat or drink for about six hours before a general anaesthetic. Often the operation will be planned for the morning, so that your child will only have to miss breakfast.
The surgeon and anaesthetist will usually visit your child before the operation. Please tell them if your child has any allergies, loose teeth or any history of bleeding problems in the family.
You may be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Operation

Most tonsillectomy operations are done in children under 15. The only effective treatment for recurrent and persistent tonsillitis is to have the tonsils removed. The tonsils will shrink in size as your child grows older, so an operation may not be necessary. Painkillers and antibiotics only provide temporary relief and are not used for long-term treatment. A viral infection won’t respond to antibiotics.
The operation usually takes about 30 minutes. There are several methods available for removing tonsils.

• Traditional Disection method - a special surgical blade is used to cut out the tonsils. Pressure is applied to stop the bleeding, and dissolvable stitches or heat is used to seal the wound.
• Laser Tonsillectomy

Post op period

Your child will be monitored and will need to rest on their side until the effects of the anaesthetic have passed. Your child will be groggy, and may feel or be sick.
Your child may complain of a sore throat, earache and a stiff jaw. Pain relief and antibiotics are usually prescribed for a week .
You should encourage your child to drink and eat as soon as they feel ready, starting with clear fluids such as water or apple juice.
After about 12 hours, a white or yellowish membrane -slough - will appear where the tonsils were. This is nothing to worry about and is not a sign of infection.
Your child will usually be ready to go home the morning after the operation. Before you go home a nurse will give you a date for a follow-up appointment.

Recovering from tonsillectomy

Once home, follow the surgeon’s advice about pain relief. You can give your child painkillers such as paracetamol or ibuprofen syrup .Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16.
If your child is prescribed antibiotics it’s important to finish the course.
Get your child to drink plenty of fluids and eat. It’s best to start with soft or liquid foods which are easier to swallow. Giving your child a dose of pain relief half an hour before meals may help make eating more comfortable. Encourage your child to brush their teeth thoroughly, at least twice a day.
Your child should rest for a few days and stay at home to avoid contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds.
If your child develops any of the following symptoms, please contact your doctor or the hospital immediately if any bleeding from the nose or throat or a high temperature
You can expect your child to make a full and quick recovery once the initial pain has resolved. Complete recovery can take two weeks.

Side effects?

Tonsillectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic. Common side-effects include:
• sore throat, earache and a stiff jaw - these side-effects may last for up to two weeks
• bad breath - this usually improves after two to three weeks
This is when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Antibiotics are usually prescribed to help prevent infection.
Specific complications of tonsillectomy are rare but include:
• bleeding within 24 hours - your child may need to go back into theatre to have it stopped
• bleeding four to seven days after the operation (secondary haemorrhage) - this can be the result of an infection
• damage to the teeth or jaw - this can be caused by the instruments used to keep the mouth open during surgery
• chest infection and breathing problems - there’s a risk blood and tissue from the operation may get into the throat and down into the lungs

Sometimes we forget how we got where we are and the choices we made or paths we took to get there. I can reflect on the day that my path was carved out the right direction .

I took a chance to come to work in Bahrain military hospital in 1986.Any how it clicked.
After completing the training in UK for 9 years, I was offered jobs in King Faisal Hospital of Riyadh (with a fat salary) and BDF Hospital in Bahrain. I opted the latter with a much less salary. The silly reason was Alcohol was plenty in Bahrain! But God “blessed” me with a bad attack of Chicken pox in 1988 and a severe Gastritis, couldn’t even drink water for days…end of the alcohol days.

Life in Bahrain was fruitful in every ways. In my carrier, in my social and personal life. I’ve learned more valuable skills in my specialty too.

Shukran Jazilan BDF

Renewal experience
It took place in 1993-Baptism in Holy Spirit

It was the long-awaited change of winter to spring in my life. In spring seeds sprout, flowers bloom, and the sun warms the earth, a time of regeneration, new beginnings, and a renewal of spirit.

The results were many, a deeper personal knowledge and commitment to our Blessed Lord ,a new meaning of all kinds of prayer, a new love of the scriptures, a new and deeper appreciation of the sacraments etc. It was new life all around.

http://www.holyspiritinteractive.net/features/charismaticrenewal/

We always desire to go back. The Israelites faced a similar problem as they departed from Egypt; upon arriving at the promised land they decided not to go in. Why? It’s too tough - there are giants in the land! And Egypt - how our life was better back then! Slavery? Well, yeah, that was a bummer, but the food was good!
When God calls you out of the world and into the promised land it’s time to get moving!

I miscalculated and made a stupid mistake in 2005. Trying to get back to “Egypt” was against God’s will. After lot of pain and humiliation , I had to return. Life may be hard. But you and God are a majority in any group; you’re in the promised land - why go anywhere else?

Again It must have been God’s will, Masha Allah.

Yawning

Everyone yawns - babies, kids, teenagers, adults. Some birds, reptiles and most mammals also yawn. However, the reason why we yawn is a bit of a mystery. There is also very little research about yawning because for most people yawning is not a problem. Here are a few things that are known about yawns:

The average yawn lasts about six seconds.
Your heart rate can rise as much as 30 percent during a yawn.
55 percent of people will yawn within five minutes of seeing someone else yawn.
In humans, the earliest occurrence of a yawn happens at about 11 weeks after conception - that’s before the baby is born!
Yawns become contagious to people between the first and second years of life.
A part of the brain that plays an important role in yawning is the hypothalamus. Research has shown that some neurotransmitters (for example, dopamine, excitatory amino acids, and nitric oxide) and neuropeptides increase yawning if injected into the hypothalamus of animals.
What’s behind this mysterious epidemic of yawning? Yawning is an involuntary action that causes us to open our mouths wide and breathe in deeply. We know it’s involuntary because we do it even before we are born.

Many people assume that we yawn because our bodies are trying to get rid of extra carbon dioxide and to take in more oxygen. According to this theory, when people are bored or tired, they breathe more slowly. As breathing slows down, less oxygen makes it to the lungs. As carbon dioxide builds up in the blood, a message to the brain results in signals back to the lungs saying, “Take a deep breath,” and a yawn is produced.

It is possible that yawns are contagious because at one time in evolutionary history, the yawn served to coordinate the social behavior of a group of animals. When one member of the group yawned to signal an event, all the other members of the group also yawned. Yawns may still be contagious these days because of a leftover response (a “vestigial” response) that is not used anymore. None of this has been proven true and yawns are still one of the mysteries of the mind.

Can Yoga cure snoring?

By doing yoga exercises, the tone of neck and chest muscles of respiration can be increased preventing collapse of the airway during REM sleep.
It may not cure the snoring completely but can help to some extent. Along with other exercise why not give a try?
Pranayama
Doing correct breathing techniques of inhaling , retaing and exhaling air, one get more oxygen to the heart and brain. Pranayama is derived from 2 Sanskrit words - Prana (life force) and Ayama (control). Therefore, in its broadest description, Prananyama would mean the control of the flow of life force.
(Yoga breathing is called pranayama, it allows prana or the life force energy to circulate throughout our body, relieve from insomnia, helps sleep, migraine, headaches, lowers the blood pressure, and massages the heart as per the Yogic teachers)

How to sleep at night
Balasana: According to a survey, those who sleep on their back, snore more loudly. Balasana is the best sleeping posture for the young as well as the old. The posture is so called because the children (bala) usually sleep in this posture. But is it that easy to keep sleeping in one posture all night long?

Migraine
(Important-Before labeling the headache as Migraine, one should rule out any ENT causes, eye pathology, Dental causes or any Neurological problems presenting as headache.)

Migraine headache is a severe pain felt on one, and sometimes, both sides of the head. Migraine headache is a form of vascular headache.
The pain is mostly in the front around the temples or behind one eye or ear. Besides pain, you may have nausea and vomiting, and be very sensitive to light and sound.

During a migraine attack, the temporal artery enlarges. Enlargement of the temporal artery stretches the nerves that coil around the artery and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the artery magnifies the pain.
What triggers migraine?
• lack of food or sleep
• bright light or loud noise
• hormone changes during the menstrual cycle
• stress and anxiety
• weather changes
• chocolate, alcohol, or nicotine
• some foods and food additives, such as MSG or nitrates

Types of Migraine?
Classic migraine
With a classic migraine, a person has these visual symptoms also called an “aura”, 10 to 30 minutes before an attack, sees flashing lights or zigzag lines and may have blind spots or loses vision for a short time
The aura can include seeing or hearing strange things. It can even disturb the senses of smell, taste, or touch. Women have this form of migraine less often than men.
Common migraine.
With a common migraine, a person does not have an aura, but does have the other migraine symptoms, such as nausea and vomiting.

How is a migraine headache diagnosed?

Migraine headaches are usually diagnosed when the symptoms described above are present.. A family history is usually present, suggesting a genetic predisposition in migraine sufferers.
Patients with the first headache ever, worst headache ever, or where there is a significant change in headache or the presence of nervous system symptoms, like visual or hearing or sensory loss, may require additional tests. The tests may include blood testing, brain scanning as MRI or CT scan
Migraine headache and Tension headache

Tension headaches cause a more steady pain over the entire head rather than throbbing pain in one spot. Most of the time, migraine attacks happen once in awhile, but tension headaches can occur as often as every day. While fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body’s hormone levels, and even changes in the weather.
Women get it more than men

Yes, migraine headaches are more common in women. In fact, about three out of four people who have migraines are women. Women also tend to report higher levels of pain, longer headache time, and more symptoms, such as nausea and vomiting.

Female hormones and migraine

Hormones may also trigger migraine. Some women who suffer from migraine headaches experience more headaches around the time of their menstrual periods. Other women experience migraine headaches only during the menstrual period. The term “menstrual migraine” is used mainly to describe migraines that occur in women who have almost all of their headaches from two days before to one day after their menstrual periods. Declining levels of estrogen at the onset of menses is likely to be the cause of menstrual migraines. Decreasing levels of estrogen also may be the cause of migraine headaches that develop among users of birth control pills during the week that estrogens are not taken.
Stress can cause migraine
Yes, stress is the most common trigger of headache.
Some things you can do to help prevent or reduce stress include doing relaxation exercises, Yoga and getting enough sleep

How is migraine headaches prevented ?

There are two ways to prevent migraine headaches: 1) by avoiding factors “triggers” that cause the headaches, and 2) by preventing headaches with medications (prophylactic medications).
What are migraine triggers?

Examples of triggers include stress, sleep disturbances, fasting, hormones, bright or flickering lights, odors, cigarette smoke, alcohol, aged cheeses, chocolate, monosodium glutamate, nitrites, aspartame, and caffeine.
For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches.
Sleep and migraine

Disturbances such as sleep deprivation, too much sleep, poor quality of sleep, and frequent awakening at night are associated with both migraine and tension headaches, whereas improved sleep habits have been shown to reduce the frequency of migraine headaches. Sleep also has been reported to shorten the duration of migraine headaches.
Fasting and migraine

Fasting possibly may precipitate migraine headaches by causing the release of stress-related hormones and lowering blood sugar. Therefore, migraine sufferers should avoid prolonged fasting.
Bright lights and migraine

Bright lights and other high intensity visual stimuli can cause headaches in healthy subjects as well as patients with migraine headaches, but migraine patients seem to have a lower than normal threshold for light-induced pain. Sunlight, television, and flashing lights all have been reported to precipitate migraine headaches.
Caffeine and migraine

Caffeine is contained in many food products (cola, tea, chocolates, and coffee) and OTC analgesics. Caffeine in low doses can increase alertness and energy, but caffeine in high doses can cause insomnia, irritability, anxiety, and headaches. The over-use of caffeine-containing analgesics causes rebound headaches. Furthermore, individuals who consume high levels of caffeine regularly are more prone to develop withdrawal headaches when caffeine is stopped abruptly.
Chocolate, wine, tyramine, MSG, nitrites, aspartame and migraine

Chocolate has been reported to cause migraine headaches, but scientific studies have not consistently demonstrated an association between chocolate consumption and headaches. Red wine has been shown to cause migraine headaches in some migraine sufferers, but it is not clear whether white wine also will cause migraine headaches. Tyramine (a chemical found in cheese, wine, beer, dry sausage, and sauerkraut) can precipitate migraine headaches, but there is no evidence that consuming a low-tyramine diet can reduce migraine frequency. Monosodium glutamate (MSG) has been reported to cause headaches, facial flushing, sweating, and palpitations when consumed in high doses on an empty stomach. Nitrates and nitrites (chemicals found in hotdogs, ham, frankfurters, bacon and sausages) have been reported to cause migraine headaches. Aspartame, a sugar-substitute sweetener found in diet drinks and snacks, has been reported to trigger headaches when used in high doses for prolonged periods.
Treatment of Migraine
Life style changes for migraine

Preventing migraine takes motivation for the patient to make some life changes. Patients are educated as to triggering factors that can be avoided. These include smoking cessation, avoiding certain foods especially those high in tyramine or those containing sulphites or nitrates .
Generally, leading a healthy life style with good nutrition, adequate water intake, sufficient sleep and exercise may be useful..
What should migraine sufferers do?

Individuals with mild and infrequent migraine headaches that do not cause disability may require only OTC analgesics. Individuals who experience several moderate or severe migraine headaches per month or whose headaches do not respond readily to medications should avoid triggers and consider modifications of their life-style. Life-style modifications for migraine sufferers include: Go to sleep and waking up at the same time each day.
Exercise regularly (daily if possible). Make a commitment to exercise even when traveling or during busy periods at work. Exercise can improve the quality of sleep and reduce the frequency and severity of migraine headaches. Build up your exercise level gradually. Over-exertion, especially for someone who is out of shape, can lead to migraine headaches.
Do not skip meals, and avoiding prolonged fasting. Limit stress through regular exercise and relaxation techniques. Limit caffeine consumption to less than two caffeine-containing beverages a day. Avoid bright or flashing lights and wearing sunglasses if sunlight is a trigger.
Identify and avoid foods that trigger headaches by keeping a headache and food diary. Review the diary with your doctor. It is impractical to adopt a diet that avoids all known migraine triggers; however, it is reasonable to avoid foods that consistently trigger migraine headaches.

Medications

There are two ways to approach the treatment of migraine headache with drugs:
1-prevent the attacks
2-relieve the symptoms during the attacks.

Medication therapies for migraine-

Pain relievers (analgesics).Paracetamol, NSAIDs-ibuprofen, naproxen etc
Many OTC analgesics are available. OTC analgesics have been shown to be safe and effective for short-term relief of headache
NSAIDs relieve pain by reducing the inflammation that causes the pain (They are called non-steroidal anti-inflammatory drugs.
Aspirin, acetaminophen, and caffeine also are available combined in OTC analgesics for the treatment of headaches.
Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics.
Precautions with OTC analgesics-
Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developing Reye’s syndrome, a life-threatening neurological disease that can lead to coma and even death.
Patients with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.
Patients with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.
Patients with advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to rapid and life-threatening deterioration of their liver disease.
Patients should not overuse OTC or prescription analgesics. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Thus, overuse of analgesics can lead to a vicious cycle of more and more analgesics for headaches that respond less and less to treatment and occur more frequently.
What is the treatment for moderate to severe migraine headaches?

Sumatriptans

The triptans attach to serotonin receptors on the blood vessels and nerves and thereby reduce inflammation and constrict the blood vessels. This stops the headache. The triptan with the longest history of use is sumatriptan .Sumatriptan is available as an injection, oral tablet, and nasal spray.
Side effects of Sumatriptans

The most common side effects of triptans are facial flushing, tingling of the skin, and a sense of tightness around the chest and throat. Other less common side effects include drowsiness, fatigue, and dizziness. These side effects are short-lived and are not considered serious. Men complaints of temporary impotency while taking the drugs.
Triptans should not be given to patients who have had heart attacks and strokes, or to patients who have symptoms of atherosclerosis such as angina, transient ischemic attack (TIAs) and intermittent claudication.
Triptans should not be used in pregnant women and are not generally used in young children.
Ergots

Ergots, like triptans, are medications that abort migraine headaches. Examples of ergots include ergotamine preparations like Cafergot and dihydroergotamine preparations Migranil. Ergots, like triptans, cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than the triptans. Therefore, they are not as safe as the triptans. The ergots also are more prone to cause nausea and vomiting than the triptans. The ergots can cause prolonged contraction of the uterus and miscarriages in pregnant women.
What other medications are used for treating migraine headaches?

Narcotics are used to treat migraine headaches; however, these medications are potentially addicting and are not used as initial treatment.
In patients with severe nausea, a combination of a triptan and an anti-nausea medication, for example, prochlorperazine or metoclopramide may be used. When nausea is severe enough that oral medications are impractical, intravenous medications such as prochlorperazine and valproate are useful.
What are prophylactic medications for migraine headaches?

Prophylactic medications are medications taken daily to reduce the frequency and duration of migraine headaches. They are not taken once a headache has begun. There are several classes of prophylactic medications: beta blockers, calcium-channel blockers, tricyclic antidepressants, antiserotonin agents and anticonvulsants. Medications with the longest history of use are propranolol (Inderal), a beta blocker, and amitriptyline, an antidepressant. When choosing a prophylactic medication for a patient the doctor must take into account the drug side effects, drug-drug interactions, and co-existing conditions such as diabetes, heart disease, and high blood pressure.
Beta blockers

Beta-blockers are a class of drugs that block the effects of beta-adrenergic substances such as adrenaline (epinephrine). By blocking the effects of adrenaline, beta-blockers relieve stress on the heart by slowing the rate at which the heart beats. Beta-blockers have been used to treat high blood pressure, angina, certain types or tremors, stage fright, and abnormally fast heart beats. Beta-blockers have been used for many years to prevent migraine headaches.
It is not known how beta-blockers prevent migraine headaches. It may be by decreasing prostaglandin production, though it also may be through their effect on serotonin or a direct effect on arteries. The beta-blockers used in preventing migraine headaches include propranolol (Inderal), atenolol (Tenormin) etc
Beta-blockers generally are well-tolerated. They can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients who already have slow heart rates (bradycardias) and heart block (defects in electrical conduction within the heart), beta-blockers can cause dangerously slow heartbeats. Beta-blockers can aggravate symptoms of heart failure. Other side effects include drowsiness, diarrhea, constipation, fatigue, decrease in endurance, insomnia, nausea, depression, dreaming, memory loss, impotence..
Tricyclic antidepressants

Tricyclic antidepressants (TCAs) prevent migraine headaches by altering the neurotransmitters, norepinephrine and serotonin, that the nerves of the brain use to communicate with one another. The tricyclic antidepressants that have been used in preventing migraine headaches like amitriptyline.
The most commonly encountered side effects associated with TCAs are fast heart rate, blurred vision, difficulty urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when standing.

What is Ear wax?

Ear wax is a sticky liquid secreted by cerumen glands in the ear canal. It isn’t really wax in the ‘candle wax’ sense (paraffin). Skin contains many tiny glands whose sole purpose is to secrete a variety of substances. Sebaceous glands, for example, secrete sebum, which gives skin its greasy quality. Sweat is also produced by microscopic glands. Cerumen glands are found only in the skin of the ear canals.
Why wax in the ear?

The purpose of this natural wax is to protect the ear from damage and infections. Usually a small amount of wax accumulates and then dries up and falls out of the ear canal, carrying with it unwanted dust or sand particles. Ear wax is helpful in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent.
Any harm if it accumulates?

Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of the skin lining the ear canal from the eardrum (Tympanis membrane) to the outer opening of the ear. Old earwax is constantly being transported from the deeper areas of the ear canal out to the opening where it can be removed by cleaning by a tissue paper or towel.
Ear wax if it accumulates, can cause hearing loss, pain, and cough. Hearing loss occurs when wax completely blocks the ear canal. This prevents sound waves from easily reaching the ear drum, in exactly the same way that ear plugs (or a strategically-positioned finger) block sound. Even a small amount of wax, if wedged between the ear drum and the ear canal wall, reduces the ability of the ear drum to conduct sound. Some people form very hard wax, which can cause pain by putting pressure on sensitive ear canal walls. Finally, since the ear canal shares some of the same nerves which give sensation to the throat, ear wax can provoke a “tickle in the throat” which can then lead to cough.
Wax problem ?

While some folks have problems with ear wax throughout their lives, many people develop “problem wax” suddenly, without any obvious explanation. Similarly, a person may have wax problems with one ear and not the other.
When should ear wax be removed?

Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn’t always the case. Ear wax may accumulate in the ear canal for a variety of reasons, including narrowing of the ear canal resulting from infections or diseases of the skin, or overproduction of wax. When wax has accumulated so much that it blocks the ear canal (and interferes with hearing), your physician may have to wash it out by syringing or using vacuum suction and remove it with special instruments. Alternatively, your physician may prescribe ear drops that are designed to soften the wax such as waxolve, otorex , soda bicarb ear drops or just olive oil
If you do try ear wax softeners without supervision, it is imperative to know that you do not have a perforated eardrum prior to using the product. Putting ear wax softeners in your ear in the presence of a perforated eardrum may cause an infection in the middle ear. Similarly, simply washing one’s ear in the presence of a perforation may start an infection. If you are uncertain whether or not you have a perforation in your eardrum, consult your ENT surgeon. Some individuals may also be hypersensitive to products designed to soften ear wax. Therefore, if pain, tenderness or a local skin rash develops, you should discontinue the use of these drops.
How to deal with ear wax?

Most primary care physicians will attempt to remove wax by irrigation (squirting warm water into the ear canal to wash out the wax) or by scooping the wax out with a curette (a very small, metal ring at the end of a metal handle). The curette technique can be very effective in skilled hands, but can be painful (and potentially damaging) in less-than-skilled hands. (Incidentally: removal of an impaction of hard wax is inevitably painful, regardless of technique.) Irrigation is always uncomfortable to some degree; some folks tolerate this better than others.
Ear, nose, and throat (ENT) doctors usually remove wax by suction and/or curette techniques. This is typically done with the assistance of an operating microscope to give the doctor optimal visibility. ENT doctors have a variety of tools to remove wax, and will typically alter their methods depending on the hardness and location of the wax.
Once wax is impacted against the drum, it can be extremely painful and difficult to remove. In some circumstances, it becomes necessary to remove the wax with the aid of a binocular operating microscope and special instruments, and using vacuum suction apparatus. After cleaning the wax, apply little antibiotic ointment if there is any inflammation.

Don’t use cotton bud in the ear

Complications that arise from self-cleaning the external ear canal are common.
The misconception of needing to clean the ear canal by introducing an object into the ear is rampant. Are you one of them? Do you often clean your ears with cotton buds? They feel good after cleaning the ear. What makes them indulge? Some say the feeling they get is more than euphoric.
Removing the wax is not good for the skin and can even cause rupture of the ear drum as seen in the picture. Sometime the loose tip of the cotton bud get lodged in the ear canal.

Most of the times the sickness will not be healed by a miracle, that will be the extra-ordinary, the ordinary, the usual way is to be healed by God but using the skills, good care and compassion of a doctor and nurse, and the care and compassion of relatives, friends, neighbors…
All healing comes from GOD. If you posses great faith, sure you will be healed by prayer alone. But those who are weak may pray along with medicine.
There is an interesting story about Moses, who once got an ear ache, went up the great mountain, met God face to face, and had a consultation. Lord asked him to take few leaves from the bush, crush it and put the drops in his ear. Wow he got healed instantly. Few months passed, Poor Moses got the earache again, and he did what the Lord told him last time. But pain persisted, angry Moses asked Lord, what is this?…Lord replied, last time you did as I told you, but this time, you forgot to consult with me…
Pray along while you are undergoing any treatments.

I am a surgeon practicing Medicine since 1973, where I have taken care of thousands of patients and have done thousands of operations. I really do my best to practice Medicine according to the standards and ethics taught by my teachers, but I acknowledge that it is God the one who really heals, using me some times… I believe it is true the statement of the Bible, “See now that I myself am He! There is no god besides me. I put to death and I bring to life, I have wounded and I will heal, and no one can deliver out of my hand.” (Deuteronomy 32:39)

If healing is an art, I consider myself as a brush in His hand; similarly, I am only a blade in the hands of Master surgeon, GOD.

Postoperative Instructions after Rhinoplasty

First 12 hrs after Surgery

once fully awaken in the theatre, you will be shifted to the ward. You can expect to have cool compresses on your eyes and cheeks to reduce any swelling or bruising that may occur following surgery. Your nose will be blocked as a result of swelling from the surgery and from the thermoplast that are placed in your nose to assist in maintaining its new shape and function. For this reason, you must remember to breathe through your mouth.
The nurses will be checking your vital signs frequently- Pulse, BP Temperature etc.

Nasal Packing

There will be a nasal pack to prevent any bleeding after surgery. We use Merocel pack with or without an airway.
If the nasal septum is straightened (Septoplasty), thin silastic splint will be sewn inside the nose to assist in keeping the septum straight while it is healing. These silastic sheets are removed by in the OPD one week after surgery. Removal of the splints is usually painless.

Columellar incision

Inverted V shaped incision on the columella should be taken care of.Keep moist with applying Neosporin ointment, avoid rubbing.

Avoid sneezing

Take antihistamine(loratidine) as prescribed by the surgeon.

Swelling and Discoloration

Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount varies from person to person, but it always seems more dramatic in the face. We suggest that you keep your head elevated as much as possible.
Your nose and eye area may remain swollen with varying amounts of discoloration for several days. The most important thing to remember is that these conditions always subside.

Remember

1. Stay vertical. Sit, stand and walk around as much as is comfortable beginning on your second postoperative day. Of course, you should rest when you become tired but keep your upper body as upright as possible.
2. Apply ice packs frequently for a minimum of 24 hours after your return home from surgery.
3. Avoid bending and lifting heavy things for one week. In addition to aggravating swelling, bending and lifting may elevate blood pressure and start bleeding.
4. Avoid hitting or bumping yur Nose. It is wise not to pick up small children and you should sleep alone for one week after your operation.
5. Sleep with head end up for 1-2 weeks following your surgery. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of the mattress. It is recommended that you sleep on your back for 30 nights. Some patients find a reclining chair placed at a 45-degree angle to be more comfortable than a bed.
6. Avoid straining while in Toilet. If you need a laxative, take Dulcolax or Creamalax tablet one at night. Proper diet, plenty of water and walking are strongly recommended to avoid constipation.
7. Avoid direct sunlight on your face for one month.
8. Avoid heavy exercise for one week following surgery.

It is not unusual to have varying amounts of discoloration in the nose and eye area. Like the swelling, it may become more pronounced, especially in the eye area, after the first day or so. Remember this is normal and temporary. It usually lasts no more than two weeks, all the while decreasing in intensity. The measures previously described that help the swelling to subside will also help diminish discoloration; however, there is no medication that will cause it to disappear rapidly - only the natural course of time.
If you have external incisions, do no apply make-up over the incisions themselves until one day after the sutures have been removed; however, you may bring make-up to the line of the incisions.

Nasal Drainage or Bleeding

You should expect some blood-tinged drainage from your nose following any nasal surgery. The hospital nurses will place a nasal pad under your nose when you are discharged from the hospital. This pad should be changed whenever it becomes soiled. If you develop active bleeding from the nose, spray each nostril 4 to 6 times with a decongestant nose spray such as Otrivine and ice pack over the Nose .You may repeat this maneuver every 10 minutes for up to 30 minutes. If bleeding continues despite these steps, call the doctor.

Cold compress

This provide the simplest and most effective cold compresses to reduce swelling, bruising, and discomfort following surgery. During your waking hours, apply the packs to the cheek and eye area around your nose for 20-30 minutes each hour for at least 48-hours following surgery.

Pain killers

Even though you may not feel much initial discomfort following your surgery, pain medication should be taken as prescribed, every 4-8 hours for the first 24 to 36 hours after surgery. We find that many patients initially feel very well following surgery and are reluctant to take any medication for symptoms of pain. Unfortunately, the patients who “tough it out” often develop discomfort 18 to 24 hours after the procedure, which may then last for 3 to 4 days. Those patients who take their medicines faithfully, as instructed, have very little, if any, discomfort. Beginning 36 to 48 hours after surgery, Diclofenac and Paracetamol is usually adequate for any discomfort you may still experience.

Antibiotics

You will take an oral antibiotic for 7 to 10 days following your surgery. All antibiotics should be taken with food or liquids to prevent nausea and promote proper absorption of the medication (do not consume milk or dairy products when taking your antibiotic as they can inactivate many medicines). Take your antibiotic as instructed by your physician until medication is completely gone. Do not forget to take your antibiotic and do no stop taking it because you feel better.

Gastric acidity

Gastric acidity develops following many types of surgery and is not uncommon after nasal surgery. You may be given a prescription medication, Rabeperazole and Domperidone capsule to be taken once daily.

Fever

Generally, the body temperature does not rise much above 100 degrees following nasal surgery. If any high fever, call the doctor.

Feeling dizzy

It is not unusual for a patient to feel weak, have palpitations, break out in “cold sweats,” or get dizzy following any type of surgical procedure especially when anesthesia has been administered. Within a few days these feelings will generally disappear without medication. Returning to a normal diet and light activity will shorten the duration of these feelings.

Not able to sleep

If you experience excessive difficulty in sleeping during the postoperative period, take mild sedative and pain killer at night. It should be remembered that such drugs also tend to make some people feel light-headed and weak and should be taken only if absolutely needed.

Resuming Activities

1. DO NOT SMOKE & AVOID ALCOHOL CONSUMPTION for 3 weeks. Both of these activities significantly slow the healing process.
2. WEARING GLASSES AND CONTACT LENSES. Eyeglasses should not be supported by the nose for at least one month after surgery. Eyeglasses may be taped to the forehead or a device called a “cheek rest” may be purchased to clip on to your glasses. (These steps are taken to avoid any external forces being applied to the nose which may result in a change in its new shape and function). Contact lenses may be inserted the day after surgery, if no eyelid surgery was performed.
3. HOUSEHOLD ACTIVITIES. On your second postoperative day, you are encouraged to be up and around the house with your usual activities; however, no bending, no heavy lifting, and no strenuous activity for 1 week.
4. PULLOVER CLOTHING. For 1 week following surgery, you should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head.
5. EXERCISE. No strenuous athletic activity or exercises that involve straining or heavy lifting for 1 week following surgery.
6. RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES. When you return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling and discoloration you develop; the average person is ready to return to work or go out socially 1 week after surgery.
7. DO NOT DRIVE A CAR for one week. Also, do not drive while taking any sedative or prescription pain medications.
Follow up Appointments
Your first postoperative appointment will occur 5-7 days after your surgery .Your second postoperative visit will be 2-3 weeks after your surgery