ENT PONNIAH’S ENT NEWS

1PONNAIAH’S ENT NEWS | MARCH 2018

March 2018Volume 1 Issue 1

PONNIAH’S ENT NEWS

ENT CARE CENTRE @ PONNIAH HOSPITAL

ENTPonnaiah_March18.indd 1 07-03-2018 08:57:14

2 PONNAIAH’S ENT NEWS | MARCH 2018

Dear Reader,Hearing is something most of us take for granted.

We approach a doctor only when a problem peaks. But, I believe, having an annual evaluation is a good idea. It doesn’t matter how well you’re hearing. It’s all the more important if you suffer from bouts of migraine. I’m prompted to say this after going through recent studies which show that those who suffer from migraine headaches have an increased risk of developing hearing loss than those who don’t.

You might wonder: What does migraine have to do with your hearing? ‘Plenty’ is the answer according to a study by researchers in Egypt’s Assiut University Hospital’s Department of Neurology and Psychology published in the American Journal of Otolaryngology. The researchers used eletrophysiological testing and looked at the function of the cochlea and auditory pathways of migraineurs compared to those who didn’t have the disease.

In the process, they discovered that two thirds of the migraineurs had one or more abnormalities. Testing included the otoacoustic emissions test (OAE) and auditory brainstem response (ABR) test, the former measures the echo produced by the vibrations of hair cells in the cochlea while the latter measures brains response to sound.

The researchers hypothesize the abnormalities could be a result of compromised blood supply to the auditory system due to migraine attack. It’s a significant finding because sensory hair cells in the cochlea depend on healthy circulation for proper functioning. A decrease in circulation could eventually result in dead or damaged hair cells causing sesorineural hearing loss.

Treatment plans for migraine could vary from individual to individual depending on the severity and pain frequency. No matter how severe or frequent the condition is, expert advice is to seek help at emergency medical facility in case you experience a sudden loss of hearing.

With regards,Yours Sincerely

Dr.K.GopinathEditor

EDITOR’S DESK

MAIL BOX

CONTENTSLASER TO THE RESCUE OF VOICE

LISTEN TO YOUR EAR PLEASE!

HEAD & NECK CANCERS: 100% CURABLE

Dear Dr.Gopinath,I’m happy to note that you’re bringing out a

monthly newsletter to highlight the activities of your hospital. Being a very old institution known for its medical expertise and reliability, I’m sure Ponniah Hospital is holding onto a treasure-trove of knowledge pertaining to medical science. I’m also certain that you would be able communicate your inherent strengths with the general public through this journal. I wish you all the best and look forward to reading the first issue.

Dr.K.Ganesh, Coimbatore

Dear Dr.Gopinath,By deciding to bring out a monthly

newsletter, you’ve taken the right decision. I know a number of rare medical cases handled at Ponniah Hospital with absolute success. What’s more I also personally know you, how you invest your time in CME to keep yourself updated and your insatiable passion towards ENT. I’m sure your journal will go a long way in disseminating valuable information about ENT and thus create greater awareness among the public. I’m eagerly waiting for the first copy of your journal.

Dr.Priya , Erode

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Medical science and doctors across the world are still trying to fully understand the

mysteries being held back by the complex structure - human brain. Yet, compared to the scene that existed a few decades before, mankind today is in a better position. For it’s been successful in unraveling some of the mysteries by illuminating the content covered and protected well by the receptacle – skull. The giant strides being made by the medical science hold out the promise of early diagnosis, accurate treatment, relief and complete well-being for the ailing population.

“For instance take the case of pituitary tumors. Its surgical management has evolved over time from transcranial to transsphenoidal (endoscopic) approach. This minimally invasive, fully endoscopic approach has completely revolutionised the treatment of pituitary tumors,” says Ponniah Hospital Managing Director and Consultant Dr.K.Gopinath.

Ponniah Hospital, the oldest hospital in Coimbatore renowned for extending quality healthcare at affordable cost has an exclusive and dedicated ENT Care Center. The hospital, which embraces emerging medical technologies with zero-time lapse, makes full use of the endoscopic advantage in treating pituitary tumors.

This innovative procedure utilizes a tiny endoscope – 2.4 mm wide and 20 cm long – with angled tips. It’s inserted through the nostril and into the skull base. This approach, says Dr.Gopinath offers numerous advantages in terms of the surgery and recovery period. What are the specific advantages of endoscopic pituitary surgeries?

“There’re a lot. First, surgeons get a vivid, panoramic view of the brain because there’s a camera placed at the tip of the endoscope. This helps surgeons in making a full visual assessment as they can look around the corners. This clear view, later, also equips the surgeons with the ability to remove the entire tumor in most cases,” says Dr.Gopinath for whom endoscopic surgery in ENT has been a passion.

This is in complete contrast with the traditional approach of viewing tumor site through

SAY GOODBYETO PITUITARY TUMORS



microscope outside the skull at a focal distance. The traditional method has its limitations at it limits the surgeon’s visibility.

The other advantage of endoscopic procedure is that it comes with no incision as the entry is gained through a nostril. This means absence of scarring, nasal packing and undisturbed brain. “We’re also able to reduce the time required for the actual surgical procedure, length of hospital stay and overall recovery period.

In other words, it means patients can return home within 24-48 hours after surgery and the rapid recovery pace also helps them to return to work and resume

normal activities sooner than one can think of.

But, are all pituitary tumors malignant? Dr.Gopinath who has special interest in skull base surgery besides micro ear surgery and cochlear implant replies in the negative. Most pituitary tumors are benign

overgrowths (adenomas), he says adding: “malignant overgrowth (pituitary carcinomas) is extremely rare.”

So, next time when you hear pituitary tumor, don’t tremble in fear since they’re treatable and in many cases curable. The optimal treatment modality depends on the size and type of the tumor and the extent of its growth around the brain at the time of diagnosis.

Gene therapy, tissue-specific promoters and stem cell therapy can further revolutionise the treatment of pituitary tumors. “But, as of now, endoscopy is the best option and early detection is the right key to successful treatment,” signs up the surgeon.

PITUITARY TUMORS – FACT SHEET

Whom does it affect?They represent approximately 10% of all

intracranial tumors. They’re most common in the third and fourth decades of life. They equally affect both sexes.

Are they genetically linked?Most pituitary tumors arise spontaneously

and sporadically and not genetically inherited. Like most other tumors the actual cause of pituitary tumors remains unknown.

When should you see a doctor?Pituitary tumors, in general, become

symptomatic either due to an endocri-nologic disturbance or due to mass effect surrounding neurovascular structures. Other symptoms are specific to specific type of pituitary tumor.

See a doctor if you experience frequent headaches, vision problems, unexplained tiredness, mood changes, irritability, changes in menstrual cycle.

What’s the best diagnostic tool?Besides complete medical history, physical

examination and hormonal studies help in the diagnosis of pituitary tumors. Magnetic Resonance Imaging (MRI) is the widely chosen tool since it can detect these tumors at a very early stage.

Why pituitary gland is crucial?Pituitary gland is mal-functional in nature

and it secretes a variety of key hormones which regulate and control the activities of virtually every other gland in the human body.

Ponniah Hospital, which embraces emerging medical technologies with zero-time lapse, makes full use of the endoscopic advantage in treating pituitary tumors



Z By Dr. K Gopinath

The use and applications of lasers have expanded fast since their invention. A relatively recent

addition though lasers now play a key role in laryngeal (voice) surgeries as they offer a time-and-cost efficient alternative to cold surgical techniques. Lasers can be used to treat a variety of medical issues concerning the vocal cords and other parts of the larynx including small and medium cancers though their efficacy would be

more pronounced in the treatment of the former.The likelihood of curing the cancer is also really

good because most cancers suitable for laser surgery are early stage cancers. Still, one needs to understand the fact that any cancer affecting the larynx may have unpredictable or aggressive natural biology and thus can pose a real challenge to the surgeons. There’s no denying the fact that good outcomes can be obtained from cold surgery. Yet, lasers possess some physiological and technical advantages.

Lasers are convenient and exact and offer

LASER TO THE RESCUE OF VOICE



surgeons an opportunity for unobstructed vision of the surgical field. Minimal tissue manipulation and a longer working distance are other distinct advantages of lasers. Other advantages include: Decreased risk of post-operative bleeding, increased sterility, minimal surrounding tissue damage and better intra-operative haemostasis (stopping of blood flow).

Laser surgery is performed through the mouth using a metal tube (laryngoscope) and microscope. In suitable cases the entire cancer can be removed in a single sitting as a day-case procedure while larger tumors might require a few nights of in-patient stay. A good access to the larynx with laryngoscope is essential for improved surgical outcome. However, in some patients, the anatomy of the larynx, tongue or prominent upper teeth might pose a hindrance.

Surgeon would be able to assess the quality of the access only after his attempts to display the tumor and hence the patient agreeing to this procedure also runs the risk of the surgeon not being able to proceed if the access to the tumor is poor.

In the case of small cancers which require minimal removal of voice cord vocal outcomes are excellent and most patients will have near-normal voices. In other words, it means the vocal outcome of laser surgery will generally depend on the how much vocal cord has to be removed. Vocal outcome may be particularly poor if some of the opposite vocal cords require removal.

A research paper published by National Center for Biotechnology Information (NCBI) confirms that laser surgery as a therapeutic endoscopic procedure provided successful treatment for early vocal cord cancer in 86% cases initially. This success rate, however, reached 96% after the incorporation of salvage treatment modalities. The NCBI study also found voice preservation in 97% cases.

Laser surgery, despite its notable benefits, is a complicated procedure. It requires the surgeons to understand the relation between power density and time of laser use and the concept of lateral thermal speed. It’s not that lasers would be suitable for every vocal cord issue. A decision to this effect would heavily depend on the surgeon’s

experience, skills and interpretation of the lesion and the anatomy of the patient needing treatment.

The operating surgeon should also be aware about the expanding options in laser surgery. This alone will help him in choosing the most appropriate laser for a given procedure on a case-to-case basis.

At Ponniah, we’ve a team of highly experienced ENT surgeons who understand physics of lasers and their applications. Being experts in treating vocal cord issues, we’re able to determine the underlying issue and the treatment that is

necessary. So, when we prescribe laser approach for a specific issue,

we’re also reasonably certain that its outcome would

be encouraging. Thus patients not only save

on money and time but they also gain peace of mind.

What’s voice?It’s the vibration of

the vocal folds which produce the sound of

your voice. The vocal folds are two bands

of smooth muscle tissue positioned opposite each other

in the larynx.

Detecting voice problems• Voice that’s hoarse or raspy• Inability to hit high notes while singing• Sudden deepness of voice• Raw, achy or strained feeling in throat• Difficulty in talking• Clearing of throats repeatedly

What causes voice problems?• Upper respiratory infections• Inflammation caused by acid reflux• Vocal misuse• Growth of vocal folds• Cancer of the larynx

Preventing voice problems• Drink plenty of water• Limit alcohol/caffeine intake• Use humidifier at home• Limit medications which dry out vocals



I’m a woman, 31 years of age, and pregnant with my second child. I’m well into the second trimester, and my sinuses are congested every morning when I wake up, and stay that way until the afternoon. Now that it’s happening, I seem to remember it from my first child, too. What causes this? Could it be a sign of a serious problem?

A: The evaluation of pregnancy and respiratory issues involves the evaluation of specialists such as internists, obstetricians/ gynecologists, pulmonologists, allergists, and ear-nose-throat specialists. During pregnancy, there are normal changes that occur during pregnancy. In the upper airway system (around the nose) there is increased blood flow, swelling, cellular activity, and certain types of mucus. This can cause pregnant women to have nasal congestion and sometimes nose bleeds. Approximately 20 to 30% of women develop this during pregnancy and this is

called pregnancy rhinitis. It is first important to ensure this is not from an acute infection or allergies. Sometimes the symptoms can be so significant that it can cause difficulties sleeping. Usually, treatment is not needed for this but there are some ways to manage this without medications. Regular exercise can result in normal constriction of the blood vessels in the nasal region to reduce the swelling. Saline nasal sprays may be helpful (as they are for various forms of rhinitis). Sleeping with extra pillows at night can help. If medication is needed, nasal ipratropium bromide may be helpful but there isn’t clear evidence to support this. Data suggests that the presence of pregnancy rhinitis does not appear to affect the outcome of pregnancy unless it is causing sleep disturbances or sleep-disordered breathing. It is not possible to make a diagnosis or management plan without seeing the patient. Therefore it is the strong recommendation to seek a referral to an ear-nose-throat specialists to be evaluated in person.

One AO

neAre stuffy noses common during pregnancy?

I am a 25-year-old male from England. I’d been suffering from nose block for quite a period. You know how irritating a nose block can be. It can also be embarrassing at times. I had tried various treatments for this long-standing problem. But, alas! After a few days of relief, the problem will recur again. It was then during a trip to India, I was recommended Ponniah Hospital. I visited the hospital and took the treatment. Today, I’m a happy person, because, my nose is no more blocked. After opening my nose block, I feel, the doctors at Ponniah have opened a new world to me. Thank you very much doctors, particularly, Dr.Gopinath.

Gary KaranagEngland

I’m a 37-year-old Keralite now settled in Germany. I had been suffering from nose block for quite some time. The blocked nose had been interfering with my day-to-day functions and it required me to carry a hand kerchief wherever I went. Clearing my nose was turning out to be a really embarrassing experience especially on occasions when I’d to attend important meetings. Then, a friend of mine suggested Ponniah Hospital where I sought treatment during one of my trips to India. I’m happy that the doctors gave me excellent treatment with such expertise that I don’t need to carry hand kerchief these days which used to be my constant companion in the past.

PraveenGermany

IN THEIR

WORDS



Life becomes a difficult and frustrating affair when one is hit by hearing disorders. These disorders

make it hard, if not impossible for one to hear. Yet, some such conditions left untreated can result in gradual but permanent hearing impairment. Otitis media also called the middle ear infection is one of the commonest forms of hearing disorder. It’s mostly observed in the early ages of children though anyone can get this problem notwithstanding his or her age.

LISTEN TO YOUR EAR PLEASE!

ENDOSCOPIC TYMPANOPLASTY



“This middle ear infection is associated with some potential pathogens,” informs Dr.K.Gopinath, ENT Consultant and Managing Director of Ponniah Hospital ENT Care Center – the undisputed leader in ENT care and treatment. It, in other words, means the infection is caused when a virus or bacteria inflames the area behind the eardrum also called tympanic membrane.

Presence of pathogens leads to pus development behind the eardrum and it causes a tear or rupture. The affected person usually feels a sharp pain, fluid drain out of ear canal and some hearing loss. “The hearing loss is usually temporary and the tear heals by itself. But, one shouldn’t neglect the infection in the event of persistent pain or fever,” cautions Dr.Gopinath.

Chronic otitis media is a long-standing, persistently draining perforation of the eardrum. “A hole in the eardrum is also called a ruptured or perforated eardrum. In some cases, doctors may need to apply a patch or do a surgery to repair the tear,” reveals the doctor.

Why is it that an intact, undamaged eardrum is so important? You’ll receive the answer only if you know how the ear works and what the eardrum is. As the name suggests, it’s like a drum because it’s a thin piece of skin-like tissue stretched tight across the opening between one’s outer ear canal and the middle ear.

The outer ear funnels the sound waves into the ear canal. The waves hit the eardrum and vibrate in the process. These vibrations are converted into signals by the middle ear and inner ear which the brain interprets as sounds. So, you know if there’s a hole in the eardrum it might not vibrate very well which can make your hearing worse. Moreover, a perforated eardrum can also allow bacteria to enter the middle ear leading further infection and hearing loss.

Tympanoplasty is a surgical technique used in treating chronic otitis media. It repairs the rupture and the goal of this procedure is to close the perforation and also to improve hearing, says Dr.Gopinath. Interestingly, Ponniah Hospital offers endoscopic tympanoplasty – the latest surgical technique – which does a clean work with minimal maneuvering with an astounding success rate.

Conventionally, middle ear microsurgery is performed under the guidance of a microscope. However, microscope which provides a linear view doesn’t allow visualization of the deep recesses of the middle ear. But, endoscopes provide magnified views of the surgical field. Unlike microscopes

The history of otology could be traced back to early Egyptian healers while Hippocrates in his time observed, ear infections may be the cause of death especially in young children. In the past, surgery’s main focus was to save the life of the child. But, today, the focus besides curing infection also extends to returning back the hearing with minimal maneuvering.

What’s otitis media?It’s an infection of the middle

ear which produces secretions which normally drain to the back of the throat through the Eustachian tube. When the fluid doesn’t drain and builds up in the middle ear, it creates a warm, moist environment where germs love to grow.

Why children are more prone to ear infections?

Blame it on the anatomy. The Eustachian tubes of children are angled less steeply than those of adults. This makes it harder for fluid to drain from the middle ear. It’s also easy for germs in the throat to work their way up into the middle ear because their tubes are shorter.

History of tympanoplasty



FactsReportedly, India has the highest prevalence of

otitis media with more than 6% experiencing the disorder.

Most school-going children in India reportedly experience at least one episode of otitis media varying from 10% to 20%.

Symptoms• Progressive hearing loss with pain

in the eardrum • Fever• Pus discharge from middle ear cavity

Endoscopic tympanoplastyIt’s the ideal for treating chornic cases of otitis

media. Being less invasive, it safer, effective and produces the best cosmetic outcomes and entails shorter duration of hospital stay.

What you get from ENT Care Centre @ Ponniah Hospital?

Ponniah Hospital ENT Care Center is the oldest and one of most renowned hospitals in South India, which has experienced doctors, state-of-the-art technology and world class expertise in treating ENT disorders with unmatched success rate.

Study. Area Overall (%) Total Number of No Individuals under study

1 Haryana 15.3% 6132 Kolkata 20% 6273 Tamil Nadu 8.6% 800

Average 14.6% 2,040

which require image adjustment during operation, endoscopes easily produce close-up and angle images, when needed, with back and forth movement. These images are so clear they’re least affected by the tortuous anatomy of the external ear canal. “Thus surgeons are able to easily obtain the view beyond the end of the endoscope. Not that alone. Magnification of the images can also be achieved through various endoscope manipulations,” confirms Dr.Gopinath. But, if the external ear canal is too narrow or blocked by a protruding bone, typonoplasty would need to wait till such time the canal is surgically enlarged, adds the doctor.

Other distinct advantages of endoscopic approach include shorter operation time, reduced exposure to anesthetic agents and associated side effect and improved surgeon concen-tration. “Being less invasive, post-operative pain and bleeding too are less. It also offers improved cosmetic outcomes, mainly because, it doesn’t leave any visible scars or require hair transplantation to the ear region,” says Dr.Gopinath.

Epidemiological study data of prevalence of otitis media in India in individuals under 10 years old



The incidence of cancer has reached monstrous proportion in our country. It’s estimated that

14.5 lakh people are living with the disease while over 7 lakh new cases are being registered every year. Reportedly, the country accounts for 5,56,600 deaths every year which are attributed to cancer, 71% of which occurring between 30 and 69 years. The five common sites of cancer diagnosed among men are lung, colorectal, pharynx, stomach, head and neck and liver.

With 77,000 new cases diagnosed every year head and neck cancers (HNCs) are the second most common cancers in the Indian population. Smoking, chewing tobacco and betel nut are the main agents for the HNC cases found in Asia, particularly, India. Some people switch from

smoking to spit tobacco thinking that it’s a safer alternative.

“But, this, of course, is not true. By switching from smoking to spit tobacco, they only change the site of the cancer risk from their lungs to their mouths. The decreasing number of lung cancer cases in countries like US and increasing number of HNCs only confirms this,” says Dr.K.Gopinath, Managing Director and Consultant Ponniah Hospital – ENT Care Center – the pioneers in treating ENT-related issues. But, the good news, according to the surgeon is that HNCs are curable if detected early. “Fortunately, most of them produce early symptoms. A person who takes the warnings seriously will seek medical help and this leads to early detection. But, knowing and

HEAD & NECK CANCERS: 100% CURABLE



recognizing the signs are very important. It can save a person’s life,” Dr.Gopinath advises.

A lump in the neckCancers which begin in the head or neck usually

spread to lymph nodes in the neck before they spread elsewhere. So, it is necessary that a physician should see a lump in the neck as early as possible if it lasts over two weeks. “But, there’s no need to get frightened. Not all lumps are cancer. But, a lump in the neck can be the first sign of the cancer of the mouth, throat, larynx, thyroid gland. These lumps are usually painless,” the doctors discloses.

Change in the voiceWhen there is a change in the

voice, it would be wise not to take chances. The change though may not be due to cancer, it would still be better to see an otolaryn-gologist who can examine the larynx easily and without causing pain. If you’re hoarse or notice voice changes for over two weeks, you should see a doctor.

A growth in the mouth

Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. Just because they’re painless, you shouldn’t take it lightly, because, cancer is often painless. There could be bleeding, but it happens only at a later stage. In the case of an ulcer or swelling along with lumps in the necks, you should immediately see a doctor.

Bringing up bloodMost often this is caused by something other than

cancer. Yet, tumors in the nose, mouth, throat or lungs also can cause bleeding. If you find blood in your saliva or phlegm for more than a few days, you should see a doctor.

Difficulty in swallowingSwallowing solid foods and sometimes even

liquids become difficult in the event of a cancer in the throat or esophagus (swallowing pipe). The food one takes might stick at certain point before going through the stomach and coming back up again. You should see a doctor if you trouble almost every time you trying to swallow something.

Changes in the skin

Basal cell skin cancer is the most common among HNCs. “Fortunately, this is not very serious provided the patient receives early treatment. These cancers appear most often on sun-exposed areas like forehead, face and ears though they can appear anywhere on the skin. This often begins as a small, pale patch that enlarges eventually producing a central dimple and eventually an ulcer. Though parts of the ulcer might heal, major portion will remain ulcerated,” says Dr.Gopinath adding: “Some basal cell cancers show color changes. Squamous cell cancer and malignant melanoma also occur on the head and neck. Most

squamous cell cancers occur on the lower lip and ear. They’re usually not dangerous if detected early and properly treated. One should see a doctor if there’s sore on the lip, lower face or ear that doesn’t heal. Malignant melanoma produces blue-black or black discoloration of the skin. Any mole that changes size, colour or begins to bleed may spell trouble. A black-blue spot on the face or neck and if it changes

size or shape, one should consult a physician fast.

Persistent earacheIf you experience pain in or around the ear while

swallowing can be a sign of infection or tumor growth in the throat. If it occurs with hoarseness or a lump in the neck, it should be considered serious. These symptoms need immediate evaluation of an otolaryngologist.

Studies reveal that 90% of the HNCs arise after prolonged exposure to specific risk factors. Use of tobacco and alcoholic beverages are most common cause of cancers of the mouth, throat, larynx and tongue. All these symptoms can also occur with no cancer present. But, you can never be sure without a proper medical examination.

“It’s very important to remember that if detected early most HNCs can be cured with few side effects. But, it all depends on how soon one seeks medical advice. At Ponniah, we see a number of cases and from our experience we can say that most HNCs are curable. But, early detection is very important. So, if you see any of the signs and symptoms mentioned here, seek medical advice fast,” concludes Dr.Gopinath.

At Ponniah, we see a number of cases and from our experience we can say that most HNCs are curable.

-Dr K. GopinathMD/ENT Care Centre @

Ponniah Hospital



Nasal fractures are the most common types of facial fractures. But, due to lack of

awareness, many people take them lightly. The result is they often go unrecognized,

unnoticed and untreated at the time of injury. Nose most commonly is the most broken bone on the head, because, it projects prominently from the central part of the face.

Your whole appearance can go for a toss because of a broken nose which can also make it harder to breathe. The fracture usually results in nose bleed and swelling both inside and outside the nose. The injured person might also find dark bruises around the eyes. The fracture can affect both bone and cartilage.

It’s important to rule out septal hematoma (collection of blood) to avoid further compressive damage to native tissue and dangerous infectious complications. A person who falls down or into contact sports is vulnerable to facial injuries leading to broken noses. Besides injuries affecting teeth and mouth may also affect the nose.

When to see a doctor?Have you been struck in the nose? Then, it’s

important to see the emergency room physician to check for septal hematoma. In case, the doctor finds a septal hematoma, it must be treated properly to prevent further complications.

However, if you suspect your nose is broken, then you should see an otolaryngologist within a week of the injury. However, if you postpone treatment beyond two weeks, it would take several months for the surgeons to surgically straighten and fix your nose.

What are the treatment options?You may not need any treatment other than rest

if your nose is broken but not out of position. But, if the fracture is very bad that your nose needs repositioning, then there are a host of treatment options. Some repairs can be done in office situations while others might need bit more elaborative arrangements.

(Next issue: Nosebleeds)

ENT EMERGENCIESNASAL FRACTURES



NASTY IS THIS NASAL DISCHARGE



All of us experience a runny nose from time to time. It’s mostly due to common

cold. So, as for the condition we mostly go by the popular adage: with medicine seven days; without medicine one week. And, sure enough, after a week, the cold is retreats and the nose bounces back to its normal state.

Yet, some people experience a runny nose for no apparent reason and notably the usual symptoms accompanying the common cold would also be absent. Such a runny nose, if neglected and not treated properly, could dangerously be woeful. That’s what happened to 65-year-old K.Kandasamy (name changed) who hails from a small town, Avinashi, near Tirupur.

A farmer by background, Kandasamy had been experiencing watery nasal discharge for nearly a year. He, in fact, had approached a number of doctors who apparently and understandably treated him for the symptoms of common cold since they were not ENT Specialists.

“But, he got no relief. It was then he heard about our hospital and approached us seeking our help. We did a total ENT evaluation which included a CT scan and discovered that he was suffering from a condition called cerebrospinal fluid leak which in short is known as CSF Rhinorrhoea,” says Dr.K.Gopinath, Managing Director & Consultant, ENT Care Centre @ Ponniah Hospital.

During the evaluation process, Kandasamy was also diagnosed with meningitis (an acute inflammation of the protective membranes covering the brain and spinal cord) which complicated the case further. “Meningitis in his was not surprising because it’s the natural off-shoot of untreated CSF Rhinorrhea,” confirms the doctor.

So, what is CSF Rhinorrhoea? How does it happen? One will understand the serious compli-cations this condition can pose only when he or she receives answers for these questions. CSF rhinorrhea occurs, when there is a hold between the dura (the tough outermost membrane enveloping the brain and spinal cord) and the skull base.

“CSF rhinorrhea can be divided into two groups; traumatic and non-traumatic. Most CSF leak cases (80-90%) occur following trauma and a majority of them present within the first three months. But, this condition can also happen due

to reasons unexplained, which we call idiopathic. Kandamasamy’s case was one such,” explains Dr.Gopinath.

The doctor further warns that a spinal fluid leak from the intracranial space to nasal respiratory tract is potentially very dangerous because of the risk of an ascending infection which could produce fulminant (severe or sudden onset of) meningitis. Kandasamy, notably, turned positive for meningitis too.

“Till some two decades back this condition and its treatment fell into the domain of neurosurgeons who performed craniotomy (opening of the skull from the top) to seal the defect. But, this procedure involved major risks including significant morbidity by brain retraction and total loss of sense of smell,” informs the doctor.

With the advent of nasal endoscopes, it however became possible for the ENT surgeons and skull base surgeons to go in for endoscopic closure of the defect. Initially, surgeons used to take donor tissues like cartilage, muscle, fat, fascia etc from other parts of the patient’s body to achieve closure of hole. But, later days, they started mobilizing tissues from within the patient’s nose and in the process surgeons achieved zero morbidity. Body parts from which tissues were mobilized however vary from patient to patient depending on a variety of factors.

“In the case of Kandasamy we closed the hole using the mobilized fat from his thigh. And, the nasal leak stopped completely and we discharged him on the third day. Today, Kandasamy is a happy person because we got rid of the nasal leak and also meningitis,” says the doctor.

Kandasamy makes it a point to visit Dr.Gopinath every now and then carrying some gifts to the surgeon, who gave him a new life, in token of his gratitude. “On occasions like these you realize how you’ve touched the heart of a person…that feeling… nothing else can replace the joy it gives,” says the doctor.

The doctor says that endoscopic approach is the best when it comes to treating CSF rhinorrhea. For, it’s minimally invasive and the blood loss is negligible. There’s no long hospital stay and the procedure is less expensive. Above all, it’s much much safer compared to opening up the skull from the top.

Real-life story



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