Role of ENT in pregnant women

 I get an opportunity to see pregnant women regularly in my outpatients.

While dealing with them it is  very important to be well versed with the ear,nose & throat issues in pregnancy & consider safe treatment.Also I do not hesitate to communicate with the referring obstetrician in front of the patient as it reduces a lot of their anxiety.

I would like to discuss some of the common ENT manifestations which happen due to physiological & metabolic changes in pregnancy.
The common presentations are nasal symptoms ,aerodigestive tract symptoms,oral changes,thyroid & ear related -hearing & balance symptoms as well as Bell's Palsy.

The commonest nasal symptom is nasal congestion & nose bleeds.These are treated with local medications & its worth noting that even cetrizine is to be avoided especially in the 1st trimester.
The oral manifestions range from pica to change in taste to mild gum bleed due to gingival hyperplasia.The symptoms of gastroesophageal reflux worsen in the third trimester.The management involves antireflux precautions & small frequent meals.The newer generation antireflux medications again to be avoided in the first trimester.
Though the ear symptoms are not very common they can be debilitating.The common presentation is of ear block due to eustachian tube dysfunction.Some of them may lead to fluid in middle ear.The risk of idiopathic facial palsy[Bells palsy] increases in pregnancy.There can also be dizziness due to iner ear fluid imbalance-Meneire's Disease.
There is a risk of thyroid enlargement during pregnancy.Investigations include ultrasound of thyroid & Fine needle aspiration.If malignancy or compression to airway only then surgery is advised in second trimester.
In conclusion,I would like to say that most of the symptoms during pregnancy are self limiting & need supportive treatment.

Evidence Based Medicine-How a doctor needs to be careful

Sharing this talk which is self explanatory
http://www.ted.com/talks/view/lang///id/1234

I enjoyed every minute of this talk.......its a sad truth.

Need of Medical Practice -involvement of patients

I have always been wondering - is there any platform where patients are patners in healthcare?This should be the gold standard & many talk about it -but there is still a long way to go..
However today I stumbled across this society & instantly became a member.The white paper is worth a read -e-Patients:How they can help us to heal healthcare.
Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.
They is already a movement amongst the select doctors in India who have realised to involve the patients.The paternalistic approach is outdated.Medicine has advanced & it is not possible for our brains to store all information about every disease.
I have been blessed with teachers who warned me early in my training days- " Do not treat the scan -treat the patient".Another warned "Concentrate on the patient -not the disease".They were visionaries .They knew how a young doctor can get carried away.They taught treating the patient not just with brain & body but with heart & soul.
Few months ago ,I have come across blog of Dr Aniruddha Malpani & have learnt alot from him.
I must mention -I still come under the pressure of finishing my appointments on time & wonder whether quantity is going to compromise quality.
I am looking for patients who can form ENT self help groups & can have discussions.There are groups on Head & Neck cancers & Pediatric ENT related groups.It will be nice to know about Indian groups as it will be more real... I feel!
I have a long way to go on this..first thing is to renew my website.
My Email is :drsheelusrinivas@gmail.com