Ear Wax

What is ear wax?
Ear wax or cerumen as it is medically called is produced by small glands in the outer 1/3 rd of the ear canal. The ear wax traps particles and protects the ear.
Why does ear wax accumulate?
Ear wax is normally pushed to the outside by normal mechanisms of the body. Common causes of ear wax accumulation include:
Use of ear buds[ Q tips]: this is the most common cause of ear wax problem: in an attempt to clean the ear, wax is pushed in deep into the ear canal and accumulates.
Use of pins/ match sticks/rolled napkin corners etc to itch ear/'clean' ears
Using ear plugs
Hearing aid users
Structural variations in ear canal producing narrow/collapsed outer ear canal
Swellings in outer ear canal- eg an osteoma

Cancer Larynx [voicebox]

Cancer Larynx [voice box]
Cancer of the voice box is one of the common types of head and neck cancers.Detected early it has excellent cure rates.
What are the risk factors for cancer larynx?
• Smoking
• Alcohol Intake
• Acid reflux [Laryngopharyngeal reflux]
• Radiation
• Other: viral [HPV], certain occupational
Are men affected more than women in cancer larynx?
Yes men are affected 4 times more than women though the incidence in women has risen significantly due to the prevalence of smoking and alcohol intake in women worldwide
What age group is affected by cancer larynx?
Age above 50 is the age most commonly affected though it can occur in other ages also.
What are the symptoms for cancer larynx?
• Persistent Voice change such as hoarseness- one of the early symptoms of cancer vocal cords.
• Difficulty in swallowing
• Pain on swallowing
• Throat pain
• Noisy breathing[ stridor]
• Difficulty in breathing
• Lump in neck
• Blood tinged spit/sputum
• Cough
• Ear pain -especially one sided
How is cancer larynx diagnosed?
• After taking your history, your ENT specialist will perform a basic Head and Neck examination.
• A mirror or a telescope/endoscope will be used to view the vocal cords and rest of the larynx [voice box] and pharynx [food pipe or throat].
• The neck will be examined for lumps, mobility of the voice box, and thyroid enlargement.
• For adequate diagnosis and planning treatment a direct laryngoscopy and biopsy will have to be performed.
What is the treatment for cancer larynx?
• If diagnosed early cancer vocal cords is one of the cancers with excellent cure rates.
• Treatment depends on the site and extent of involvement + consideration of other health issues the person may have.
• Treatment options :
o Surgery
o Laser surgery
o Radiation therapy
o Chemotherapy
o Combination therapy
How can cancer larynx be prevented?
• Do not smoke
• Do not drink alcohol excessively
90 % cancer larynx patients smoke and drink hence avoidance of these bad habits go a long way in prevention
Prompt consultation with an ENT specialist in your locality in case of persistent hoarseness is an important step in early detection and cure.

Vocal Cord lesions

Vocal cord Lesions
What are Vocal Cord Lesions?
Vocal cord lesions are abnormal masses which have developed within or along the margin of the vocal cords .They affect the voice by altering the vibration of the vocal cords.
What are the common Vocal Cord Lesions?
• Vocal nodules
• Vocal polyps
• Vocal cord cysts
What Are The Symptoms Of Vocal Cord Lesions?
• Change in voice quality
• Persistent hoarseness
• Vocal fatigue
• Delayed voice initiation
• Low pitch
• Voice breaks
• Airy or breathy voice
• Inability to sing in high, soft voice
• Increased effort to speak or sing
• Hoarse and rough voice quality
• Frequent throat clearing
• Extra force needed for voice
• Voice "hard to find"
How are Vocal Cord Lesions diagnosed?
Vocal Cord Lesions are diagnosed by your ENT specialist after doing a basic examination to view your vocal cords .This may be with a mirror or a telescope/endoscope.
What is the treatment of benign [noncancerous] Vocal Cord Lesions?
Treatment depends on the nature of the lesion and may be
• Medicines
• Voice care and Speech therapy
• Microlaryngeal surgery

Voice Care

Voice care-How to Keep Your Voice Healthy
• Drink enough water. Moisture is essential to keep your vocal cords well lubricated.
• Do not shout or scream. These are vocal abusive practices which put a lot of strain on the lining of your vocal cords.
• Warm up your voice before heavy use such as in singing, teaching a class, preaching, or giving a speech. Warm-ups can be simple, such as gently gliding from low to high tones on different vowel sounds, doing lip trills (like the motorboat sound that kids make), or tongue trills.
• Do not smoke- not only does it increase the risk of laryngeal cancers [voice box cancers] it is injurious to the vocal cords.
• Use a mike/microphone-When giving a speech or presentation or singing considers using a mike to lessen the strain on your voice.
• Listen to your voice. When your voice is complaining to you, listen to it.
• Do not strain your voice further when it is already hoarse
• Avoid throat clearing frequently- if you are clearing your throat frequently there might be some underlying problem.
• Avoid straining the voice when you have a cold
• Be aware of the medications you use some such as over the counter cold medications can dry up secretions and affect your voice

Voice

Our voice is produced by the vibration of the vocal cords caused by air passing out through the voice box [larynx] bringing the cords closer together. Proper care and use of your voice improves the likelihood of having a healthy voice for your entire lifetime.
How Do I Know If I Have A Voice Problem?
• Change in quality of voice- voice sounds harsh or rough
• Pain on speaking- a sharp or dull pain may occur on speaking for long
• Voice breaks on singing or speaking
• Loss of pitch
• Loss of voice range
Tips To Identify Voice Problems
Ask yourself the following questions to determine if you have an unhealthy voice:
• Has your voice become hoarse or raspy?
• Does your throat often feel raw, achy, or strained?
• Does talking require more effort?
• Do you find yourself repeatedly clearing your throat?
• Do you feel a lump sensation in your throat?
• Do people regularly ask you if you have a cold when in fact you do not?
• Have you lost your ability to hit some high notes when singing?
What is the cause for the change in my voice?
It may be broadly divided into:
• Vocal cord inflammation- such as in acute laryngitis
• Vocal cord lesions
• Vocal cord paralysis
• Dysphonia
• Laryngopharyngeal reflux [acid reflux]
• Vocal cord cancer - a change in the voice is often the first symptom of cancer larynx[ voice box] and prompt detection and treatment has excellent cure rate
Why do voice problems occur?
Conditions affecting the vocal cords producing a change in the voice may develop due to:-
• Smoking
• Excess voice use
• Voice abuse as in screaming or shouting
• Acid reflux[Laryngopharyngeal reflux]
• Infection
• Injury as in an accident or following intubation [ for a surgery or for ventilation support]
• Hormonal imbalance- thyroid problems[hypothyroidism]
• Drugs :- many drugs can have an injurious effect on the voice- inform your ENT specialist if you are taking any regular medicines
• Neurological conditions
What should I do if I have a problem with my voice?
• Take care of your voice-Do not strain it further by shouting, singing ,whispering or talking more than is necessary
• Drink adequate fluids
• Keep your acidity under control
• Visit an ENT specialist in your locality

Head and Neck Cancer

Head and neck cancers account for 3- 10 % of cancers worldwide but in the Indian Subcontinent it accounts for upto 45 % of cancers. Worldwide the occurence of these cancers is increasing.Awareness of the signs and symptoms goes a long way in early detection and cure.
What all cancers are are the main head and neck cancers?

1. Voice box[ larynx]


2. Nose ,sinuses, nasopharynx[ at back of nose]


3. Mouth and throat - [ lips ,lining of mouth,tongue,pharynx]


4. Thyroid


5. Salivary glands

Who is affected?

• Sex: both males and females are affected though in general it is more in males


• Age: more in older age groups

What are the risk factors ?

1. smoking tobacco is the number 1 risk factor for head and ncek cancers


2. alcohol


3. tobacco and betel nut chewing- gutka,pan


4. genetic contribution in some


5. viral infections [epstein barr virus for carcinoma nasopharynx,HPV for certain pharyngeal cancers]


6. radiation


7. occupational risk- exposure to some agents increases cancer risk

• asbestos industry


• wood workers,textile industry


• mustard gas,plastics


• nickel,paint,cement ,pesticides

What are the warning signs and symptoms ?

1. lump/swelling in neck


2. white discoloration in mouth


3. red discoloration in mouth


4. bleeding from nose or mouth


5. difficulty swallowing-cancer throat


6. pain on swallowing- cancer throat


7. change in voice or hoarseness- for cancer larynx[ voice box]


8. alteration in speaking - if affecting tongue and throat


9. ulcer in mouth, lips or tongue-they are painless at first and all the more sinister


10. swelling in mouth lips or tongue


11. persistent ear pain


12. gum swelling

What are the preventive strategies?

• Stop smoking


• Consume alcohol only in moderation or best not at all


• Take timely treatment for warning signs and symptoms of head and neck cancers stated above


• Do not use pan or gutka


• Self examination of mouth and neck on a regular basis