"Covid Vaccine" - Dr. V. Rajagopal

Persistent Colds: Viral or Allergic/Non Allergic Rhinitis

Now the season of colds & upper respiratory tract infections have started. Monsoons bring in these fevers & colds. Some people just suffer with recurrent colds & today we talk about the same.

Many people with persistent rhinitis say they have a 'persistent cold'. However, colds are due to virus infections, and normally only last a week or so.

Persistent colds or Rhinitis is not due to an infection. Common symptoms include: sneezing, a blocked or congested nose, a watery discharge ('runny nose'), and an itchy nose. Less common symptoms include: itchy throat, loss of smell, face pain, headache, and itchy and watery red eyes.

What Causes It?
Allergic rhinitis 
A common cause of persistent rhinitis is an allergy to house dust mite or to a pet.
House dust mite is a tiny creature that is present in every home. It mainly lives in bedrooms and mattresses, as part of the dust. It usually causes no harm, but some people are allergic to the tiny droppings (faeces) of the mite.
Pets - dander or hairs from a cat, dog, horse, hamster, etc, are the cause of the allergy in some cases.
Other allergies are less common. An allergy to something at work sometimes occurs. For example, to laboratory animals, or to latex or other chemicals. This may be suspected if symptoms ease at weekends or on holidays.Symptoms of allergy in the nose are due to the immune system reacting to the allergen (such as pollen, mite droppings, or dander from a pet).
Cells in the lining of the nose release histamine and other chemicals when they come into contact with the allergen. This causes inflammation in the nose (rhinitis).

Non-allergic rhinitis 
There is various other causes or 'triggers' for the symptoms. These can cause a rhinitis in their own right, but they can also make symptoms worse if you already have an allergic rhinitis. They include the following.Irritation of the nose by smoke, strong smells, fumes, changes in temperature or humidity.

Hormone changes during pregnancy, puberty, and after the menopause can sometimes cause nose symptoms.
Food and drink - mainly hot, spicy food, or alcohol. Sensitivity to certain food colourings or preservatives may be a cause.
Emotion such as stress can affect the nose.
Medication - a side effect from certain medicines is a rare cause. These include: beta-blocker medicines, aspirin and other anti-inflammatory medicines, the contraceptive pill, and ACE inhibitors (angiotension converting enzyme inhibitors).Other conditions of the nose sometimes cause similar symptoms. For example, nose polyps or chronic (persistent) sinusitis.

Are Any Tests Needed?Usually not. Most cases are due to allergy, and the symptoms are usually typical. Treatment is much the same, whatever the cause of the allergy.
Allergy testing may be advised if treatment is not helping, or to confirm the exact cause of an allergy if you want to try and avoid it

What Is The Treatment?
The commonly used treatment options for allergic rhinitis are: antihistamine tablets for short course, and steroid nose sprays for persistent cases.
In my own practice, I have been advising Nasal saline drops on regular basis during this season along with steam Inhalations. This has tremendously helped the milder cases and reduced the duration of medication for severe ones.

Allergen Avoidance is the mainstay of treatment:
Avoiding the cause of the allergy If you can avoid the cause of an allergy, symptoms will stop. This is not as easy as it sounds.If you are allergic to house dust mite, you may find that symptoms are less severe if you reduce the number of mites in your home. This is hard work and involves using bedding covers, and regular cleaning and vacuuming with particular attention to your bedroom and bedclothes. However, it is impossible to keep your home completely clear of house dust mites.
If a pet is the cause, then for some people it is easy to give up the pet. However, for others it would be a great sadness to lose a pet. It may help if you keep pets out of the main living areas, and in particular, out of your bedroom.
How Long Is Treatment Needed For?Persistent rhinitis is an ongoing (chronic) condition that usually needs regular treatment to prevent symptoms. However, over time the condition may ease, and even goes completely in some cases.

Headaches and Migraine Awareness Month: An ENT Surgeons Perspective

The month of June is celebrated as Headache and Migraine Awareness Month

I have written about Sinusitis in Adults  https://sheelusrinivas-entpractice.blogspot.com/2012/10/i-have-got-sinus-information-about.html  and Children  https://sheelusrinivas-entpractice.blogspot.com/2017/01/sinusitis-in-children.html

Today, we will discuss headaches in ENT outpatient settings and when do we take help of other specialists including Neurologists or a Sleep Specialists.

Headaches can be acute or chronic. There can be associated symptoms like an aura, intolerance to light or sound, nausea and so on.
The location and duration of attacks also help in diagnosis.
A good history can clinch a diagnosis.
Depending on the age group: Young, middle age and older patients, the differential diagnosis of headaches change.
I would like to give advice for patients with chronic headache is to maintain a diary of headache and what medications were taken.

After a detail history, thorough clinical examination and looking for risk factors and signs :a diagnosis is reached.

Migraines form one of the commonest diagnosis and presentation of headache in clinical practice.
Sharing an interesting video on Migraine:
https://www.youtube.com/watch?v=jHffEt-MXjI

Our Pediatric deafness services during Covid times: What can wait and what needs to be addressed?

Covid 19 lockdown has had impact on all of us,more so on lives of children with disabilities.

Children with hearing and speech difficulties can have hearing problem which is reversible or irreversible.

Reversible hearing loss includes children with fluid in the middle ear and leading to conductive hearing loss.Majority of these children respond to medical management.
If they do not show improvement in hearing after 8-12 weeks of medical treatment, this fluid needs to be drained or removed by a procedure called Myringotomy.

Another example of reversible hearing loss is children with cholesteatoma or chronic ear infection.
If not addressed appropriately, children with conductive hearing loss can also have speech and communication problems and scholastic backwardness as they have difficulty in noisy classrooms.


Irreversible or permanent hearing loss in children is usually referred to sensorineural hearing loss from birth or gradually progressing from birth. These children will have long term effects on speech, communication and hearing.
These children need to be diagnosed with audiology team and fitted with hearing aids. This has to be followed with dedicated speech therapy. Children who do not develop age appropriate speech with aids will be considered for cochlear implantation.

Apart from the direct impact of hearing loss on speech, wearing of masks and disruption of therapy services have effected children and families.

We have been available to these families on phone and Whatsapp. Once the lockdown was released, we have been triaging the needs of children and calling them for tests and hearing aid fitting. Our families benefitted with teleconsultations.

Our commitment lead to BERA/ABR tests in a baby 9 months old to hearing aid fitting in the baby. We also diagnosed and gave hearing aid to a 4 year old.
Though we avoided performing routine ENT Surgeries,we performed myringotomy and grommet insertion and mastoid surgery in a 5 year old.
We have been following all necessary precautions for the safety of ourselves, our staff and children and their families.
We will have to be careful for the coming months but make sure that further damage and morbidity is not added to our already diagnosed medical problems.

Little ones matter: Role of Prevention in Pediatric ENT

During these Covid times, everyone id anxious especially about hospital visits.Here we discuss some preventive aspects in Ear Nose Throat Diseases

Hope you like and share it

https://www.facebook.com/watch/live/?v=273713967310099&ref=watch_permalink

Online Schooling:Can Knowledge accumulation replace Education?

Being a mother of a teenager, I am going through a first hand experience of online schooling. As a Medical professional, I absolutely agree with the closure of schools and need of social distancing in the present Covid 19 pandemic scenario.However, I get really worried of the assumptions that online education is here to stay.

Just about the time that most of us parents had started acknowledging the perils of exposure to gadgets and online gaming and not to forget the issues of "rote" learning: Covid has left us with no choice! 

I found a thought provoking article on online schooling which I want to share here: https://www.weforum.org/agenda/2020/04/coronavirus-education-global-covid19-online-digital-learning/
Does this mean that online learning is going to replace schools? Difficult times have difficult choices!

Schools take care of the mental,social and physical growth of our children.Schools build characters and societies of tomorrow. In a school routine, the child learns the importance of being on time, discipline, friendship, empathy and so many early lessons of life.

Teachers play an important role in the lives of young children.They take care of each child depending on her or his abilities and interests. Parent teacher meetings are an eye opener for many of us parents who get to know the social interactions and educational interests of our kids.This feedback will be incomplete on an online platform which has limitations on judging overall development of a child.

Online also gets boring.

During an online class, there can be technical difficulties and children may need help from an adult.

There have been reports suggesting that students undergoing online education usually underperform and have poor practical outcomes. Adult online learning has proven this time and again. Online can be additional learning but cannot replace school learning.

For a country like ours, it can also be an extra economic burden on many families and education providers.

I hope our children are not deprived of the wonderful memories of the school environment: the school grounds, science labs, sports days,debates,science exhibition and annual day.These are the occasions which even we parents look forward to.

So,let's pray that happy days will be back soon and schools get back to accomplishing what they are best at: "Citizens of tomorrow".

My faith gets stronger when my 13 year old announces "Mummy, I want to go to school and meet my friends....."

Once a new normal resumes, we will respect our schools and the role of teachers in kids lives even more.

The Optical Journey in ENT Surgery: Ever expanding role of Endoscopes

Travelling From Nose to Orbit to Pituitary to Base of Skull.

 Diagnosing and treating Airways diseases.

Exploring Middle Ear to Inner ear and Internal auditory canal.

Sialendoscopes help us to explore the 3mm to 5mm salivary ducts and many instances saving the removal of salivary glands.

Presenting my experience of ongoing journey of learning and updating as a surgeon:
There is a cognitive bias and better control of emotional state as a senior surgeon, but learning a new skill involves extensive pre reading and attending hands on courses, learning from colleagues and discussion with experts in the field from various parts of the world.
We also need to invest in the telescopes and dedicated instruments. We procured our Sialendoscopes and Penetti Ear Surgery instruments for the program.

Anatomy does not change, but with better visualisation-- newer terminologies to be learnt to have a syatematic and scientific approach to diseases and surgeries.As an Otologist, I learnt new endoscopic anatomy of middle ear: Protiniculum, Finiculum, Fustis, Subtympanicus and so on.

Sharing our recent work :

                                            Optic Nerve Decompression (Traumatic injury), 

                                                    Sialendoscopy for recurrent sialadenitis, 

                                               Endoscopic Ear Surgery for attic disease.