VOCAL HYGIENE

How to get the best mileage from your voice

When you have a voice disorder, it is important to take good care of your voice. Most voice disorders can be prevented. Here are tips to help keep your voice healthy:

• Hydrate every day: Drink at least 6 to 8 glasses of water each day. Water helps keep the vocal cords moist and gets rid of extra mucus.
• Avoid dry, artificial interior climates (air-conditioned or heated rooms): It is good to use a cool mist humidifier to keep your throat, lips and nose from getting dry. Steam inhalation also helps.
• Limit coughing and throat clearing
• Avoid irritants: This includes airborne irritants like smoke, dust and fumes; liquid irritants like milk, coffee and tea (caffeine tends to dry out the throat), and alcohol.
• Do not smoke
• Do not whisper: Whispering can cause vocal cord damage.
• Avoid speaking for excessive amounts of time
• Avoid speaking in a noisy environment, or talking over a long distance
• Do not yell, scream or cheer
• Avoid harmful vocal patterns: sudden tense initiation of voice, using unnatural pitch, grunting, talking in a monotone pitch, or talking when you are too tired, are all harmful to the vocal cords.
• Avoid speaking over the natural breath cycle, squeezing out the last words without sufficient breath support.
• Laryngopharyngeal reflux (LPR): LPR refers to a spill over of acid from the stomach into the throat. If left untreated it may inflame the vocal cords and cause permanent damage to your voice.

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T.M.J PAIN / DYSFUNCTION

T.M.J. pain or dysfunction refers to the symptoms produced by poor function of either the T.M.J. (jaw joint), or the muscles around the joint. This problem is at the border of areas of concern between Otolaryngologists and dentists, and is often diagnosed and managed by either / both specialities.

Causes:                                                                                                                               

• Stress and jaw clenching from stress                                                               
• Overbite or other dental misalignment                                                        
• Ill-fitting dentures
• Leaving dentures in overnight
• Clenching teeth by day or grinding teeth at night
• Excessive gum chewing

Symptoms:

• The main symptom is pain in or around the ear, which is often the reason for misdiagnosis of the condition. This is because the back wall of the jaw joint makes up the front wall of the ear, the chewing muscles surround the ear, and the same nerves supply both the ears and the joint. The pain is worse in the morning if you grind your teeth at night, and worse as the day progresses if other bite or jaw problems exist. Also, if ear pain is triggered by a blast of wind then it is more often than not due to TMJ dysfunction.
• Headache /facial pain/ neck pain
• Jaw clenching or grinding
• Ringing in the ears

Diagnosis:

This condition is most often diagnosed from patient history and clinical examination. Seldom is imaging necessary (e.g. CT / MRI). If symptoms persist in spite of conservative measures, contact your ENT surgeon to be re-evaluated.

Treatment:

• This condition is usually chronic and requires time, persistence and patience to overcome

• Avoid chewing gum
• If you have dentures, make sure they fit well. Try leaving one or both plates out at night to rest the jaw muscles
• Eat a soft, non–chew diet until the pain is gone
• Use local heat to the jaw area, such as a heating pad or hot water bottle
• You should see a dentist for underlying dental or bite problems
• If you grind your teeth or wake up with T.M.J. symptoms your dentist can make a splint to help this problem

Muscle relaxants like Flexeril, pain killers and intramuscular Botox^® injections may be an option in select cases (Please discuss with your ENT surgeon for more details).

 

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TINNITUS

 

What is tinnitus?

Tinnitus is a phantom sound or noise perceived in the ear(s) most often described as “buzzing, ringing, crickets, whistling, humming, static, high pitch tone”. It may range from extremely mild and intermittent sound, to highly incapacitating, continuous noise. It is common problem, about 1 in 5 people have it. Quite often, for the patient suffering from chronic, annoying, or debilitating tinnitus, hearing loss is a major concern. Approximately, 80% of all people with sensorineural hearing loss (SNHL) have tinnitus, and 80% of all people with tinnitus have SNHL.

Types and causes of tinnitus: There are 2 types of tinnitus

1. Non -pulsatile tinnitus: It is the most common type of tinnitus, representing 90-95% of all tinnitus presentations. It occurs in the absence of a known external stimulus. The usual causes are hearing loss (mostly sensorineural loss, sometimes conductive loss), Meniere’s disease, patients who have had surgery in their ears, some drugs like salicylates in high dosage, streptomycin, quinine like drugs for malaria, and certain anti-anxiety pills. In most cases the cause remains unknown.
2. Pulsatile tinnitus: This type is heard by the patient and the physician, and has a physical sound source. It is usually due to a disorder in the blood supply in the head and neck, or dysfunction of some muscles of the throat.

Management of tinnitus: The management of tinnitus is tailor-made for each patient. The following are some of the techniques used to help patients cope with tinnitus.

• Tinnitus Retraining Therapy (TRT): The goal of this therapy is to habituate the person to their tinnitus with the help of counselling sessions combined with sound therapy using tinnitus masking devices (constant low level broad band sound). This therapy is usually provided by audiologists specially trained in TRT.
• Cognitive Behavioural Therapy (CBT): This treatment is offered by psychologists that helps people cope better with on going symptoms like tinnitus.
• Drugs play little or no role in the management of tinnitus. Anti-anxiety pills or sleeping pills are sometimes prescribed for patients with severe tinnitus.
• Tinnitus may be treated with hearing aids or masking devices.
• Patients who have trouble falling asleep due to their tinnitus are advised to tune into FM static between stations, or asked to have a ceiling or table fan turned to full speed, to provide a constant noise to override their tinnitus.

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MENIERE’S DISEASE

What is Meniere’s disease?

Meniere’s disease is an inner ear problem possibly caused by fluid build-up in the inner ear structures. The disease is characterized by spontaneous episodes of severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, a feeling of fullness in the ear, headaches, and nausea and vomiting – any combination of these symptoms is possible.

How is Meniere’s disease diagnosed?

No single test makes the diagnosis of Meniere’s disease. Rather a complete history that includes a detailed description of the pattern of disease presentation, supported by quantitative testing, is required. A complete audiological test battery followed by Videonystagmography (VNG) is performed at our clinic, to confirm the diagnosis. A computed tomography (CT) or Magnetic resonance imaging (MRI) of the brain may also be ordered to rule out other causes of dizziness.

How is Meniere’s disease treated?

Meniere’s disease is usually self limiting, therefore the long – term outcome for balance function is good. Although there is no absolute cure for Meniere’s disease, the following steps prove to be helpful.

1. Avoid salt and caffeine
2. Avoid smoking and limit alcohol consumption.
3. Stress and psychological issues can exacerbate your symptoms
4. In the case of severe dizziness with nausea, with/without vomiting – rest quietly and take Gravol (as directed by your doctor).
5. For on-going dizziness and prevention of episodes – Serc 8 mg – 16 mg 3 times daily, orally. If you experience side effects while taking this drug, call your doctor. Your doctor may tell you to stop taking Serc, or suggest a way to manage the side effect. The most common side effects are skin rashes and gastric upset.
6. A diuretic may also be prescribed. For example, Dyazide one tablet daily orally. You must see your family physician in one month for blood testing to ensure safety of the medication.
7. If the above fails, a stronger diuretic may be prescribed. Diamox 250 mg twice daily orally. Common side effects include numbness and tingling of the face and hands. If you experience these side effects, stop the medication or contact your pharmacist.
8. If your dizziness is absolutely incapacitating and interfering with the quality of your life, then you may be a candidate for steroid injections through your ear drum.

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EAR WAX REMOVAL

Your ear canal produces a waxy oil commonly known as ear wax. This wax protects the ear from dust, foreign particles, and microorganisms. It also protects the ear canal skin from irritation due to water. In normal circumstances, excess wax finds its way out of the canal and into the ear opening naturally, and then is washed away. When your glands make more ear wax than is necessary, it may get hard and block the ear. If you clean your ears with a Q tip, you can accidentally push the wax deeper, causing a blockage. Wax buildup is a common reason for temporary hearing loss.

Two simple remedies may be tried at home for this.

 

	Hydrogen peroxide	Mineral oil
How to use	Using an eyedropper with full strength hydrogen peroxide, put several drops in each ear a few times a week	Using an eyedropper, put a few drops of mineral (or baby) oil in each ear twice a day for 2 or 3 days a week, until you see your ENT surgeon
How does it help	Keeps the wax soft and allows it to drain properly	Allows the wax to soften, so it is easy to clean
If I have ear tubes in place	SAFE to use	DO NOT USE
If my ear is painful	DO NOT USE	DO NOT USE
If I have a hole in my eardrum	DO NOT USE	DO NOT USE
Precautions	Do not get the hydrogen peroxide near your eyes Some people may not be able to tolerate hydrogen peroxide, discontinue use if any discomfort arises and contact your doctor immediately	None

Tilt your head so your ear faces up. Gently pull the ear backwards and upwards to straighten the ear canal. Using a dropper, squeeze in a few drops, followed by a cotton ball to keep the solution in. In a few minutes, remove the cotton and allow everything to drain out.

 

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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

 

What is BPPV?

It is a condition of the inner ear characterised by vertigo which is triggered by specific changes in the position of the head. Small crystals(otoliths) are found embedded within the delicate sensory hairs within the inner ear. These small hairs help the inner ear with creating a sense of balance. Sometimes, these small crystals can break loose. These otoliths then brush against other nearby hairs, causing a sensation of vertigo.

Why these crystals break loose is unknown. Older patients (over 40 years old), previous head injury, surgery involving the skull, and migraines are thought to be risk factors for developing BPPV.

What are the symptoms of BPPV?

• Sensation of spinning caused by head movement or rolling over in bed
• Maybe accompanied with nausea, vomiting, sweating or feeling unwell
• Lasts for several seconds up to a minute
• May have a feeling of being off balance between spinning episodes

How is BPPV diagnosed?

BPPV is diagnosed with the help of history and a thorough clinical examination. A Videonystagmography (VNG) is done to confirm the diagnosis. A head CT or MRI maybe ordered to rule out other causes of dizziness.

How is BPPV treated?

Although distressing at first, most episodes of BPPV are self limited. The crystals eventually find their way out of the inner ear. This can be helped with home exercises or physiotherapy.

It is important not to put yourself in situations where you could hurt yourself or others by being dizzy. Be aware of your surroundings and what activities might put you at risk for a fall.

Physiotherapy: Special exercises are shown to you by the vestibular physiotherapist. These movements are designed to work with your inner ear to let the crystals float out of your inner ear. Usually, only a few sessions are needed to help.

If you are unable to access physiotherapy services, a home maneuver can be tried.  

Epley Maneuver: The Epley maneuver is used to relocate the crystals, relieving the vertigo. This maneuver is demonstrated in the diagram below.