Prof. Dr. Rohit Mehrotra M.S.(ENT) Surgeon

COVID-19 FROM THE FRYING PAN TO THE FIRE

...

The 2nd wave of corona has been very harsh on India. Lack of Hospital beds, Oxygen and ventilators and once you get it, stay in the hospital and the expenses. It has been a difficult time for everyone. Once you get corona you have to not only come out of it, but escape post covid-19 complications. That is why it is said from the FRYING PAN INTO THE FIRE.

If you are diabetic and you have had steroids, you can land up what is known as black fungus or mucormycosis, Now fungus and bacteria are part of our daily natural habitus. They are in the nose, throat and lungs, now when you get corona your body immunity is lowered, if your sugar and Iron levels are high, the fungus attackes the nose, sinus and the eye, this is called mucormycosis. In No time the mucormycosis spreads to the eye, and brain and may cause death.

Treatment: After corona if you feel pain in the face or the eye & swelling, bleeding, discharge from the nose, headache, you should immediately consult with the ENT Surgeon. Your CT Scan and MRI has to be done immediately. Nasal swab & Biopsy to be done for fungus, if it is mucormycosis then surgical debridement has to be done. After that Inj Amphotericin B & Antifungal posaconazole have to be given.

Prevention: Follow Covid-19 appropriate behavior, so you don’t get corona,If you get corona, be very alert for all above symptoms. Control your sugar level, use Saline Nasal Spray to wash the nose, consult ENT Surgeon at the early stage, mucormycosis is a deadly disease which causes blindness and its life threatening. Intervention at the right time can save you.

कैसे समझें ब्लैक फंगस ने कर दिया अटैक, क्या हैं बचाव के उपाय Black Fungus

...

मित्रो आज कल चर्चा का विषय है कि ब्लैक फंगस इंडस्ट्रियल ऑक्सीजन क़े इस्तेमाल से हो रहा, मेडिकल ऑक्सीजन की कमी के कारण इंडस्ट्रियल ऑक्सीजन पूरे देश में इस्तेमाल की गई और अब यह देखा जा रहा है कि ब्लॉक फंगस के केस कोरोनावायरस पीड़ित मरीजों मैं बढ़ गए है। जितनी भी मेडिकल स्टडीज और रिसर्च हुई है, उसके आधार पर यह साफ तौर पर कहा जा सकता है कि इंडस्ट्रियल ऑक्सीजन और ईंधन इसके लिए जिम्मेदार नही है इसके विपरीत ब्लैक फंगस के केस उन मरीजों में देखे जा रहे हैं जिनमें डायबिटीज है और जिनमें कोरोना वायरस के इलाज के दौरान स्टेरॉयड का इस्तेमाल हुआ है साथ ही साथ जिनकी बॉडी इम्युनिटी बहुत कम है।

ब्लैक फंगस एक सामान्य प्रकार का कीटाणु है जो आमतौर पर हवा में, हमारे नाक, मुंह, गले, खाने की नली में सभी जगह पर रहता है, यह एक सामान्य फंगस है जो इंसानों और जानवरों के साथ जीता है और हमें कोई दिक्कत नहीं देता है।

यदि आपको करोना हुआ है और कोरोना के लगभग 10 से 15 दिन बाद आपको चेहरे पर दर्द होता है या भारीपन लगता है,आँखों व सर में दर्द होता है, नाक से सांस लेने में दिक्कत होती है या नाक से कला या सफ़ेद पानी आता है तो यह सारे लक्षण हमें अलर्ट करने के लिए हैं कि आपको ब्लाक फंगस (मुकरमैक्सिस) हो सकता है, अतः आपको तुरंत नाक कान गला विशेषज्ञ की सलाह लेनी चाहिए और चेकअप कराना चाहिए। विशेषज्ञ सबसे पहले आप का सिटी स्कैन करवाएगा और सीटी स्कैन से यह जानकारी उपलब्ध हो जाएगी कि आपको साइनस में फंगस तो नहीं है, दूसरा अगर जरूरत समझेंगे तो नेसल एंडोस्कोपी कराएंगे, जिससे ब्लैक फंगस डायग्नोज हो सकता है। यदि फंगस का शक होता है तो MRI कराया जा सकता है।

एक बार ब्लैक फंगस डायग्नोसिस बन गई तो इसका इलाज दो तरीके से हो सकता है, पहला है सर्जिकल ट्रीटमेंट, सर्जरी के माध्यम से फंगस को निकालना जाता है और एक बार फंगस को निकालने के बाद एंटीफंगल दवाइयां के द्वारा जो कि लगभग 3 से 6 महीने तक चल सकती है, यह निर्णय चिकित्सक द्वारा मरीज कि वर्तमान स्तिथि को देखते हुए लिया जाना चाहिए। दूसरा मेडिकल ट्रीटमेंट है, मेडिकल ट्रीटमेंट में Inj Amphotericin B और Antifungal posaconazole दो दवाइयां हैं जिनको चलाकर फंगस से लड़ा जा सकता।

अगला सवाल आया है कि ब्लैक फंगस इतना खतरनाक क्यों है ?

ऐसा इसलिए है कि अगर फंगस नाक में होता है तो वह तुरंत आँखों को इफेक्ट करता है और बहुत तेजी से हमारे दिमाग में चला जाता है, अगर है फंगस दिमाग में चला गया तो यह जानलेवा हो सकता है इसीलिए उसको जल्दी पकड़ना जरूरी है। स्टेज - १ और स्टेज - 2 में उसका ट्रीटमेंट हो सकता है और आप ठीक हो सकते।

Meditation with tinnitus is hard but not impossible When my Tinnitus was at their worst, my quality of life was in shambles and there were a lot of things I thought I would never be able to do again.

...

Meditation was at the top of the list.

I had been meditating daily for several years when chronic illness tore through my life. It had been a transformational practice, helping me to finally get my anxiety under control after more than a decade of panic attacks and generalized nervousness.

But as my tinnitus worsened, it became impossible to meditate. I just couldn’t focus anymore with the sound of sirens blasting in my ears and it was devastating. I had lost not just my quality of life, but one of the most powerful coping tools that I had relied on for years to maintain my wellbeing.

One night, lying in bed, once again struggling to meditate, I suddenly had an idea: What would happen if I stopped fighting to ignore the ringing while I tried to focus on my breath, and focused on the sound of my tinnitus instead?

At first, it seemed like such a crazy idea to focus on the sound that was driving me crazy.But I was frustrated, and I was willing to do anything at that point to try to fix the problem, so I gave it a shot. And the 15 minutes that followed changed everything.

First Signs of Hope

As I hesitantly shifted my focus to the sound of my tinnitus, the first thing I noticed was that it was difficult to do, but not for the reasons you would expect.

Meditation is a simple exercise, but difficult in practice, because it’s hard to stay that focused on anything. As I went back to the practice, I also found that I was able to fully concentrate for the first time since my tinnitus began.

Importance of early age of cochlear implants in infants.

...

What is Brain Plasticity?

When the child brain is under the development process 0-3 yrs of age and How experiences reorganize neural pathways in the brain. Long lasting functional changes in the brain occur when we learn new things or memorize new information. These changes in neural connections are what we call neuroplasticity.

What is Critical Period?

The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

Why Cochlear Implant Is Important In Early Age of Childhood?

Children’s learn to talk by listening and copying their parents, adults and the world around them. When infants babble, it's part of their language development; they're experimenting with communication and mimicking the words they hear.

Hearing is one of most important sense to their language development, which affects how they interact with others and how they perform at school.

As early possible you treat hearing loss, the better chance your child may have to develop language equivalent to a normal-hearing child. Children who received cochlear implants at six months old display stronger language skills compared to those treated when they were two years old.

(VEMP) Vestibular evoked myogenic potential (VEMP)

...

Vestibular evoked myogenic potential (VEMP) testing is a relatively new vestibular testing technique that determines vestibular function by applying a repetitive sound stimulus to one ear and then averaging the reaction of the muscle activity in response to each sound click or pulse.

This test just approved by the Food and Drug Administration (FDA).

Unlike caloric testing or rotational chair testing, VEMP does not measure eye movements. Surface EMG recordings over the ipsilateral sternocleidomastoid muscle (cervical VEMP [cVEMP]) is believed to assess function of the saccule. Surface EMG recordings over the contralateral inferior oblique (ocular VEMP [OVEMP]) is believed to assess function of the utricle.

One night, lying in bed, once again struggling to meditate, I suddenly had an idea: What would happen if I stopped fighting to ignore the ringing while I tried to focus on my breath, and focused on the sound of my tinnitus instead?

A VNG may be done by a primary health care provider or one of the following types of specialists:

An audiologist, a health care provider who specializes in diagnosing, treating, and managing hearing loss.

An otolaryngologist (ENT), a doctor specializing in treating diseases and conditions of the ears, nose, and throat.

Why do the BERA test BERA

...

The Brain Stem Evoked Response Audiometry (BERA) is an objective test that gives us the approximate average hearing threshold level of the subject.

Hearing loss in children is difficult to know from the beginning. Hearing loss can cause speech, language, cognitive, social and emotional problems. Therefore, it will be better if the hearing test in children is done early.

Healthy hearing is when the auditory nerve is able to transmit sound impulses from the ear to the brain at a certain speed. The BERA test can provide information on whether nerves convey sound impulses to the brain and whether the speed of sound delivery is within normal limits. This hearing examination can determine the type of abnormality (conductive or sensorineural), severity (hearing threshold), and hearing loss (inner ear or other parts) of the child.

In addition, in determining the hearing threshold, BERA is also used in otoneurologic diagnosis. This is useful for patients with unilateral or asymmetrical hearing loss (hearing nerve tumors, brain tumors, other nerve disorders, multiple sclerosis, etc.).

We can hear now all sounds EAS System

...

Do you feel that your hearing aids are just not good enough to hear all sounds very clearly?

If you have high frequency hearing loss you may be missing out on hearing high-pitched sounds [s],[z] etc When you cannot hear high-pitched sounds, you have a type of hearing loss known as High Frequency HL This type of hearing loss is commonly seen in each group of population.

A EAS is wonderful technologies in which have: cochlear implant technology for high-pitched sounds, and hearing aid technology for low-pitched sounds. By using two different technologies in one device, you can hear the full range of sounds, making it much easier to chat with friends, enjoy music, and communicate in everyday life.

(Oto Acoustic Emission) OAE

...

The OAE test is used to find out how well your inner ear, or cochlea, works. ... There are hair cells in the inner ear that respond to sound by vibrating. The vibration produces a very quiet sound that echoes back into the middle ear. This sound is the OAE that is measured.

OAE test can be done as early as 12 hrs after birth in NICU.