Take the Sleepiness test

Epworth Sleepiness Scale

Do you have sleepiness issues?

Do you suspect having sleep issues? Do your friends and family constantly keep reminding you to freshen up? How likely are you to doze off or fall asleep in the different situations such as while reading, watching tv, etc?

The Epworth Sleepiness Index helps you assess your sleepiness by quantifying your chances of dozing off in different situations. Even if you have not done some of these things recently try to determine how they would have affected you. The Epworth Sleepiness Scale helps understand if a patient needs medical attention or not. If you have a Sleepiness Issue, you can always consult the Sleep Disorder Specialists at Dr Rao’s ENT. We are equipped with state of the art sleep lab to assess problems such as sleep apnea & snoring to help provide the right treatment.

Go ahead and answer few simple questions to find for yourself your sleepiness index!

To know more visit this link.


Dr Chaitanya Rao undergoes Advanced Sinus Training at IRCAD Taiwan

Dr Chaitanya Rao undergoes Advanced Sinus Training at IRCAD Taiwan in a quest to become the best Sinus Specialist in Hyderabad (India)

We are proud to share that our Managing Director, Dr GVK Chaitanya Rao, has undergone training in advanced Sinus Surgery at IRCAD, Taichung, Taiwan. Dr Chaitanya Rao who is a member of American Rhinology Society(ARS) and European Rhinologic Society(ERS), joins the list of select ENT Specialists from India to have undergone this training. His areas of expertise include Nose & Sinus surgeries and this training extends his expertise further & places him as the best Sinus Specialist in Hyderabad (India).

About IRCAD, Taiwan

The course was held at IRCAD Taiwan between 15-16 February, 2019 for select ENT Professionals of various nationalities with the objective of equipping them with advanced techniques in Sinus Dissection. The course also gives insights into the global best practices and learn from the peer group.

Advantage to Dr. Rao's ENT patients

Dr Chaitanya Rao believes that in order to deliver the best treatment to patients, doctors need to constantly keep themselves up-to-date with the emerging methods and the training at IRCAD was in this direction. He firmly believes that continuing medical education should be part of every ENT specialists’ DNA. Dr Chaitanya supports his belief by training other ENT specialists through Dr Rao’s ENT Workshops.

With medical advancements, surgeries are becoming safer, efficient and less worrisome to patients. Therefore, by undergoing regular CME programs, doctors can ensure these advancements reach the patients.

Through these programs our doctors will also get exposure to the global best practices. These practices are absorbed into the processes we follow at Dr Rao’s ENT. It has been the vision of our founder & renowned ENT Specialist, Dr GVS Rao, to constantly drive knowledge up-gradation and this has been an integral part of our approach since inception.

Objectives of the training were as follows

  • Structured anatomic preparation, each step referring to clearly defined anatomical landmarks, after concise lectures and master dissection.
  • Dissection training with HD-videoendoscopy, a large variety of microsurgical instruments, shaver and navigation.
  • Intensive supervision with a experienced supervisor.
  • Specific adjunctive course material like access to essential videoclips of all important surgical steps.
  • Each complete, nature-identical anatomical specimen is subjected to preparation by two participants.


Free ENT Screening Camp in association with VR4U in Manikonda, Hyderabad

Dr Rao’s ENT Super Specialty International Hospital in association with VR4U Group organized a free ENT Screening Camp in ZPH Govt School, Manikonda on 27 January, 2019. We are happy to do our bit in spreading awareness about ENT Health and thank all our patrons who participated in the camp to make it a success.


14th Asia Oceania ORL & HNS - 71st AOICON 2019

Dr Rao’s ENT is proud to have successfully hosted the 14th Asia Oceania ORL & HNS – 71st AOICON 2019 as Surgical Venue. Dr Jacques Magnan & Dr Didier Portmann, renowned international ENT Specialists appreciate the contribution of Dr Rao’s towards the success of the conference. We are happy to share our coverage on TV5.


Why ear discharge can indicate a more serious condition and should never be ignored

Ear Discharge can indicate something serious as in the case of Mr Loganathan from Tamil Nadu who has been suffering from severe ear discharge coupled with intense headaches and sharp pain in the right ear! On medical investigation, it was found that the discharge was caused due to Cerebrospinal Fluid(fluid surrounding the brain) leaking through his ear. Mr Loganathan was saved by timely medical intervention and surgery.

Our expert take, “Ear discharge can often be due to ear wax but can also indicate something more serious such as ear infection, ruptured ear drum, mastoiditis, head injury, etc. Ear discharge is just a symptom which can have a serious underlying cause. If you notice ear discharge in your family member, rush to your nearest ENT specialist like Dr Rao’s ENT to get a thorough diagnosis as any delay can prove fatal depending on the cause.”

The problem –

Mr Loganathan met with a road accident in 2010 where he escaped a head injury, following which he underwent tympanomastoidectomy (surgery to treat infections) in his right ear. In 2012, Mr Loganathan was given ear drops to dissolve the ear mass in his external ear.

Know more here – http://www.newindianexpress.com/cities/chennai/2018/dec/18/namakkal-native-suffers-brain-palpitation-apollo-docs-save-life-1913304.html

Symptoms –

  • Mass in his external ear
  • Severe ear discharge
  • Pulsating sound in his right ear
  • Pink, insensitive mass filling his external auditory canal

Treatment –


Breathing through the mouth - Causes, symptoms & harmful effects

Is mouth breathing bad for your health?

In human beings nasal passages perform multiple tasks, the air we breathe when it goes through the nasal passages gets warmed, humidified and filtered before it reaches our lungs. Dust, allergic items like pollen and other debris which may carry microbes are removed thereby acting as a natural filter and a first line of defence. We are deprived of these benefits when we breathe through our nose. Also nose performs the dual purpose of sensing smell which is totally lost when we breathe through our mouth.

 

What are the types of mouth breathing?

Mouth breathing can be classified into three types –

  1. Obstructive
  2. Habitual
  3. Anatomic

What causes mouth breathing?

There may be various causes for mouth breathing and it may vary from children to adults. The common causes of mouth breathing are as follows –

  1. Blocked sinuses
  2. Swollen tonsils or adenoids
  3. Deviated septum
  4. Obstruction of nostrils
  5. Facial irregularities
  6. Dental issues
  7. Allergies
  8. Chronic respiratory infections

Children or adults who breathe through their mouth chronically may be deprived of sleep which may cause long periods of fatigue, affecting studies and work. Prolonged mouth breathing may result in facial and dental abnormalities making matters worse. It is also noticed that mouth breathing may result in insufficient oxygen supply causing heart issues, high blood pressure, snoring and sleep apnea.

Hence it is highly advisable to visit an ENT doctor if you notice a prolonged period of mouth breathing. Often in kids, mouth breathing manifests as mouth odour, snoring and irritable behaviour due to insufficient sleep.

You can consult a doctor if your family members exhibit any of the following symptoms –

  1. Snoring
  2. Bad breath
  3. Dry mouth and hoarseness of voice
  4. Chronic fatigue and tiredness
  5. ADD (Attention Deficit Disorder)
  6. Nasal tone while speaking

Early detection always results in taking necessary corrective measures thereby preventing lasting damage and issues at school or work. Book an appointment with the ENT experts at Dr. Rao’s ENT to diagnose your mouth breathing issues.


Stridor – Nothing sound about this!

Stridor is usually caused by a blockage in the windpipe or obstruction in the upper airway. It is important to detect the cause for the proper treatment of Stridor, as it can occur due to illness, infection, the presence of foreign objects or congenital throat abnormalities.

Types

Inspiratory Stridor: It is caused by airway obstruction above the glottis.

Expiratory Stridor: It is indicative of an obstruction in the lower trachea.

Biphasic Stridor: It suggests a lesion in or below the glottis.

Causes

Laryngomalacia is the most common cause of chronic Stridor in children. Croup is indicative of acute Stridor.

Anatomy: The anatomical structure of a child’s airway can also be a cause of Stridor. The upper airway in children is shorter and narrower than that of an adult, and is therefore, more likely to lead to obstruction breathing problems.

Larynx Collapse
: This is a very common cause for Stridor. The narrowed or collapsed parts of the larynx (commonly referred to as voice box) cause obstruction in the airway.

Subglottic Hemangioma: Arare airway disorder in children, it is characterised by the formation of a mass, consisting of blood vessels in the voice box, which causes obstruction in breathing. The child may require a surgery if the obstruction is severe.

Vascular Rings: It is an unusual condition when the abnormal formation of the aorta or other structures like arteries or veins compress the airway or windpipe.

 

Tonsillitis and ViralCroup can also cause Stridor in children.

Symptoms

Abnormal sound: Stridor can be identified with the abnormal sound when we breathe in or out.This sound indicates a problem with the tissue above or near the vocal cords.

Windpipe blockage: Expiratory Stridor creates discomfort particularly during breathing out, and is accompanied by abnormal sounds.The reason could be a blockage in the windpipe.

Shortness of breath: The individual may not be able to take deep, long breaths because of the narrowing of the windpipe.

Diagnosis
Identifying and establishing the exact cause for Stridor is of utmost importance to treat Stridor accurately. The specialist may ask you questions that include:

  • Whether skin and nails have changed colour to blue
  • Whether the child has inserted any foreign object in the nose/mouth
  • If the person is finding it difficult to breathe
  • The rate of breathing
  • If the person is suffering from a cold or bronchial infection

The consulting physician may also prescribe tests such as X-rays, bronchoscopy and laryngoscopy for better diagnosis.

 

In the event that your specialist presumes a disease, he/she may advise you to undergo a sputum culture. This test checks mucus from the lungs for infections. It enables the specialist to check whether a contamination, for example, Croup is present or not.

Treatment
Treatment options vary from person to person, depending on the age, cause and severity of the problem.

The Specialist may also:

  • Suggest that you visit an ENT specialist
  • Prescribe oral or injected medication to reduce swelling in the airway
  • Recommend hospitalization or surgery in acute cases


Rheumatic Fever – Symptoms, Causes and Diagnosis

Everything in this universe is consequential, so is human life on this planet. A human body is probably the finest machine that one can find on this planet, and everyone should treat their bodies as they would treat a prized possession. We should ensure that we take a proper care of bodies. Rheumatic fever is an inflammatory disease that arises as the result of the untreated or inadequately treated strep throat or scarlet fever. A throat infection which is caused by the bacterium Streptococcus pyogenes, if left untreated may cause rheumatic fever.

Children belonging to 5-15 years of age are commonly diagnosed with the disease but it could also happen to the adults. This disease still remains common and prevalent in South Central Asia and African counties. Rheumatic fever could be a serious life-threatening disease because if it is not treated properly it can lead to Rheumatic heart fever. Rheumatic heart fever can cause infection to the valves and heart failure.

Causes of Rheumatic fever:

Rheumatic fever is caused by Group A Streptococcus bacterium which causes strep throat, and in some individuals, it may also cause an inflammatory disease called scarlet fever.

The strep bacteria have a similar protein that resembles the one found in certain tissues of the body. It manipulates the immune system into the treating the body’s own tissues as an infection and produces the antibodies which attack the body tissues specifically the tissues of heart, joints, skin and nervous system.

Symptoms:

Rheumatic fever symptoms do not remain same for all and may vary from person to person. These symptoms usually develop within 2-3 weeks after strep throat infection manifests. The symptoms include the following.

  • Painful joints or arthritis
  • Fever with a temperature above 101F
  • Sore throat
  • Fatigue
  • Nausea and vomiting
  • Headache
  • Swollen tonsils
  • Difficulty in swallowing
  • Chest pain
  • Difficulty in breathing

Treatment:

Treating the rheumatic fever involves completely getting rid of the traces of the Group A Streptococcal bacterium, treating the symptoms and controlling the inflammation. It includes the following

Anti-inflammatory treatment:

Anti-inflammatory treatment includes the prescription of pain relievers like aspirin or naproxen to relieve the pain, break the fever and reduce the inflammation. If the patient does not respond to the medication, the doctor might recommend corticosteroids.

Antibiotics: You will be treated with antibiotics like penicillin to destroy all the traces of the strep bacteria. This antibiotics medication may continue for 5 years to prevent the recurrence of rheumatic fever. In case of a damage to the heart, the doctor will recommend antibiotics medication for 10 years or longer


Alcohol effects on Sleep Apnea

Sleep apnea and alcohol is a dangerous cocktail mix. Alcohol consumption before going to bed can induce sleep apnea and other sleep disorders. A study by the researchers reveals that the alcohol consumption at night may cause obstructive sleep apnea, since alcohol tends to relax the muscles in your body which include the throat muscles that collapse, blocking the airway that leads to the lungs. When the airway is blocked, the brain usually sends a signal forcing you to wake up and clear the airway passage. Alcohol reduces the chances of your reflexes, diminishing the chances of your awakening from the sleep during the sleep apnea.

Does alcohol invite the Sandman?

Not really. In fact, alcohol decreases the amount of your REM sleep. It is a myth that a swallow of your favorite drink before going to bed will help you sleep well because the human body tends to develop tolerance to the alcohol after a few nights.

Lack of sleep forces you to increase the quantity of the alcohol consumption, but it results in frequent disruption of the rest. When your body metabolizes the alcohol, it causes excessive sweating, loud snoring, headaches and the regular visits to the bathroom apart from the sleep apnea.

So, Quit alcohol?

If you are diagnosed with sleep apnea, the best advice is to abstain from alcohol. If you wish to enjoy a drink or two (not more than that), consider drinking several hours before you go to sleep. Limit the alcohol consumption if you have to drink.

Does alcohol affect men and women differently?

Sleep apnea is relatively common among the males than the females. However, women absorb alcohol more because they have fewer enzymes to break down the alcohol molecules. Women are likely to get the higher concentration of liquor despite drinking the same amount as men, which may cause disrupted sleep, snoring, nightmares and headaches.

Women are advised to have alcohol at least 4 hours before the sleep, and the quantity should be restricted to as minimum as possible.

If you have snoring or OSA (Obstructive sleep apnea), it is time to visit best ENT doctor in hyderabad at Dr. Rao’s ENT hospitals


Snoring in children

Snoring in children

Mouth breathing and snoring in children is not healthy. Snoring in children is caused because of enlarged adenoids, tonsils, with or without co-existing allergies. If medical treatment is unsuccessful and the problems are recurrent, surgical removal should be planned.

Adenoids and snoring

Adenoids is a lymphoid tissue sac situated in the roof of the throat behind the soft palate, where the nose opens into the throat.

It is a vestigial organ whose absence will not have any adverse effects on the human body. It is seen in children up to 7 years of age, after which they atrophy and disappear entirely.

Adenoids enlarge in size due to recurring nose and sinus infections, which do not give an opportunity for adenoids to subside in size. Adenoids also act as a reservoir for bacteria during infections and protect them from the antibiotic action, slowly releasing them later leading to recurring nose and sinus infections.

Adenoids block the eustachian tube openings present just behind the nose. Proper functioning of eustachian tube is essential for ventilation of the ear, the absence of which leads to ear pain, ear blockage, fluid formation in the middle ear. Children with fluid in the middle ear may complain of intolerance to loud sounds.

Tonsils and snoring

Tonsils, another vestigial organ, when enlarged also lead to snoring by compromising the space available behind the mouth, through which air has to pass once it reaches the back of nose while breathing.

Allergic rhinitis and snoring

Allergic rhinitis causes enlargement of tissues of the nose, especially turbinates compromising the nasal space available for the air to flow through.

Snoring is harmful

Breathing through the nose is essential as nose acts as an air conditioner and filter protecting the lungs from harm and stress. Enlarged adenoids and tonsils cause mouth breathing which causes bypassing of critical functions in the nose.

Snoring is associated with sleep apnea in most of the children which cause disturbed sleep. Children with sleep apnea struggle for breath while asleep, and keep moving all around the bed in the process of finding a sleeping position where they can breathe well. Sleep apnea causes the child to be cranky, hyperactive. The child will lack concentration and stability. Most of these children tend to overeat causing obesity.

Management of snoring in children

Medical management with nasal decongestants, oral decongestants, nasal washes, nasal steroid sprays can be tried for snoring and mouth breathing.

Despite long-term medication, if the resolution of symptoms is incomplete or symptoms are recurring on a regular basis, we have to plan for surgical removal of adenoids, tonsils with or without turbinate reduction for allergic patients. If the fluid is present in the middle ear, grommetplacement in eardrum can be clubbed with adenotonsillectomy.

Allergic children will have to use anti-allergic medication and nasal sprays even after surgery to mellow down the hyper-reactivity of the nose in response to exposed allergens.


Can snoring kill you?

Have you ever wondered why young people in their 30’s and 40’s are getting heart attacks and some sadly are passing away? Snoring and associated obstructive sleep apnea is now emerging as one of the causes.

Snoring which until recently was considered a nuisance to your bed partner is now emerging as a killer. Snoring, the harsh sound produced by air forcing its way through narrow passageways in the throat, causing the relaxed muscle tissue to vibrate.

How can snoring kill you?

There are now multiple studies showing the link between snoring, obstructive sleep apnea and early onset of co-morbidities such as diabetes, hypertension, heart attack, stroke, obesity, daytime sleepiness – causing falling off asleep at driving wheel leading to vehicular accidents.

Snoring is most of the times a symptom of Obstructive sleep apnea, a now emerging dangerous health condition.

Do I have obstructive sleep apnea?

You most likely have obstructive sleep apnea if you are experiencing any of the following

  1. Your snoring is so loud that it can be heard in the next room
  2. Your bed partner is noticing that you are suddenly stopping snoring (and breathing) in the midst of your sleep or you are seeing that you are choking for breath in your sleep.
  3. Lack of freshness in the morning after a regular 7-8 hour sleep
  4. Sore and dry throat when you wake up in the morning
  5. Lack of concentration at work
  6. Dozing off in between meetings or when inactive at work for 5-10 minutes
  7. Kids respond differently to disturbed sleep because of snoring and sleep apnea by being hyperactive throughout their active hours.

What causes snoring and obstructive sleep apnea?

When you breathe, the air has to pass through many passageways before reaching the lungs.

In order, the air passes through

  1. From front to back of nose reaching the top of throat
  2. Through the throat behind the soft palate, the muscular structure at the roof of your mouth
  3. Through the throat behind the tongue
  4. Through the throat into the Larynx – the voice box
  5. Windpipe

During sleep

The throat is surrounded by sheet-like muscles called constrictors and other palatal muscles.

These muscles maintain a particular tone under signalling from the brain when you are awake, keeping the air passageway patent. When you sleep, the brain stops signalling the muscles to maintain tone, and they relax, narrowing air passageway to a certain extent. The following conditions can further narrow down the air passageway, forcing the air through very narrow passageways causing relaxed neck muscle tissue to vibrate causing snoring.

  1. Nose and sinus conditions such as deviated septum, hypertrophied turbinates, sinusitis, nasal polyposis
  2. Palatal conditions such as bulky and elongated soft palate (the muscular structure at the roof of your mouth), elongated uvula (the triangular structure hanging from soft palate), enlarged tonsils.
  3. Fat deposition in the neck circumferentially as seen in obese people
  4. Bulky tongue and small jaw pushing the tongue back

In obstructive sleep apnea, the obstruction to air passageway becomes so severe, that only very little air is allowed and sometimes no air is allowed to reach the lungs. This causes the oxygen levels in the body to drop to alarming levels, and these low oxygen levels (and high Co2 levels) signal the brain to immediately wake you up so that you can deeply breathe and replenish the oxygen levels in your body. Your brain responding to such an emergency releases certain chemicals such as adrenaline to force-start your breathing, and these chemicals are what is responsible for the early onset and progression of co-morbidities which we spoke about previously.

How can Obstructive sleep apnea (OSA) be diagnosed?

An ENT surgeon following a physical examination of your ENT may request for one or many of the following diagnostic tests. The idea is to recognise the site of blocks in air passageway

  1. Sleep study
  2. Dynamic MRI – OSA protocol
  3. CT of Nose and Sinuses
  4. Cephalometry
  5. Sleep endoscopy

How can OSA be treated?

OSA can be treated in a multitude of ways. The following are the options available. Few of them can be used standalone, and few need to combine to get the required results

  1. Oral appliances
  2. CPAP
  3. Upper airway tract surgery

Remember the saying “A stitch in time saves nine”, Don’t merely ignore snoring – make sure you do not have OSA and if you do, it is better to start treatment immediately to let your family members sleep in peace – with you by their side.


Fishbone in the throat

If it is a Sunday, our endoscopy department would be working full force with many patients visiting us with foreign bodies. The most common culprit is the fishbone, throwing its one last punch before being assimilated by the gastric juices.

Fishbone and any other foreign body if stuck in the throat can most of the times be pushed away with a gulp of water or with a large soft bolus of rice. If this manoeuvre doesn’t relieve you of your pain or discomfort after trying a few times, it means that the foreign body has lodged deep in your throat. It is imperative at this point not to meddle your throat with your fingers or induce gawking or vomiting as this would only worsen your discomfort. It means the time has come for you to visit your ENT surgeon.

Most of the foreign bodies we have seen till now either lodge into the tonsils, back of the tongue, side walls of the throat and few times deep in the throat at the entry of the food pipe.

On visiting your ENT surgeon, He will thoroughly examine your throat under headlight for any visible foreign bodies.

Any foreign bodies lodged in the tonsil can be visualised and removed under headlight illumination.

The foreign bodies in the back of the tongue, sidewalls of the throat and in the deeper parts of the throat cannot be visualised with headlight when he will suggest a Video laryngoscopy.

Video laryngoscopy (VLS) is a very well tolerated outpatient procedure in which a small amount of anaesthetic is sprayed onto your palate, back of tongue and back of the throat to numb them. An endoscope is advanced through your mouth to visualise the back of tongue, voice box and entry of food pipe. Once the foreign body is visualised, it is removed with the help of instrumentation.

In very few cases your doctor may not be able to remove the foreign body under VLS guidance, when he may suggest its removal under general anaesthesia.

On VLS, Sometimes no foreign body is visualised, but the patient still feels the discomfort, pain. In most of these cases, it could either be because the foreign body caused abrasions on the way to the stomach or because of the finger manipulation done by the patient before visiting the doctor. In very few of these cases, the foreign body is very deeply seated, not visible to naked eye, when radiological investigations will be ordered or “wait and watch policy” is undertaken. A two day period is given when the patient is asked to carefully watch for increasing pain, the start of fever, swallowing or breathing problems, and if they occur, he is asked to visit the doctor immediately.

This is a video of one of my patients who had fish bone lodged deeply into the entry region of the food pipe (aka cricopharynx). You can see me and my colleague Dr Laxminath removing it. At our hospital, we have two doctors working in tandem to remove such deeply lodged foreign bodies. While one doctor visualises the throat with the endoscope, another doctor uses his two hands on instrumentation to precisely remove the foreign body.

This is a box with all the removed foreign bodies stored from the past year (sometimes the patients insist on taking the removed foreign body with them) stored at a top secret place in our hospital. Maybe next time you visit us, you can ask us to have a look at it.