Diseases Treatment

What is this Condition?

Tonsillitis is inflammation of the tonsils. It can be acute or chronic. The uncomplicated acute form usually lasts 4 to 6 days and commonly affects children between ages 5 and 10. The presence of proven chronic tonsillitis justifies surgical removal (tonsillectomy), the only effective treatment. Tonsils tend to grow during childhood and shrink after puberry.

What Causes it?

Tonsillitis usually is caused by infection with bacteria known as group A beta-hemolytic streptococci. It may result from other bacteria or viruses or from oral anaerobes.

What are its Symptoms?

Acute tonsillitis commonly begins with a mild to severe sore throat. A very young child, unable to complain about a sore throat, may stop eating. Tonsillitis may also produce difficulty swallowing, fever, swelling and tenderness of the lymph glands in the submandibular area, muscle and joint pain, chills, malaise, headache, and pain (frequently felt in the ears). Excess secretions may cause the child to complain of a constant urge to swallow; the back of the throat may feel constricted. Such discomfort usually subsides after 72 hours.

Chronic tonsillitis produces a recurrent sore throat and pus-filled drainage in the tonsillar crypts. Frequent attacks of acute tonsillitis may also occur. Complications include obstruction from swollen tonsils and an abscess around the tonsils.

How is it Diagnosed?

Diagnostic confirmation requires a thorough throat exam. The doctor notes generalized inflammation of the pharyngeal wall, swollen tonsils, and the presence of drainage with pus. The person may also have a swollen, inflamed uvula (the small, fleshy mass hanging down in the back of the mouth).

Lab tests are also important in making a diagnosis. Cultures may determine the infecting organism and indicate appropriate antibiotic therapy.

How is it Treated?

To treat acute tonsillitis, the doctor will prescribe rest, adequate fluid intake, aspirin or Tylenol and, if the person has a bacterial infection, antibiotics. If the organism causing tonsillitis is a group A beta­hemolytic streptococci, the doctor will usually prescribe penicillin, although another antibiotic may be substituted.

To prevent complications, antibiotic therapy should continue for 10 to 14 days. Chronic tonsillitis or the development of complications (obstructions from swollen tonsils or abscess around the tonsils) may require surgical removal of the tonsils. This operation should take place only after the person has been free of tonsillar or respiratory tract infections for 3 to 4 weeks.

An abnormal growth of spongy bone can occur at the entrance to the inner ear and immobilize the base of the stirrup, a tiny bone through which sound waves pass into the inner ear. As a result, the stirrup cannot transmit some or all of the sound waves that enter the ear. This causes conductive hearing loss in that ear. In about 80 per cent of all cases of otosclerosis, both of the ears are affected, either the two at the same time or one after the other.

What are the Symptoms?

Without treatment, otosclerosis usually leads to a slow loss of hearing, eventually ending with total deafness in both ears within 10 to 15 years. In a few cases, usually in children, the hearing loss progresses much faster. In some other cases the hearing loss stops well short of deafness. For example, someone with the disorder may be able to hear loud speech and other loud sounds.

At first, the affected person’s voice sounds normal, unlike the abnormally loud voices of people with other types of hearing loss, As the disease progresses, some sensorineural hearing loss may occur. If this happens, it may cause noises in the ear and louder speech.

A woman with otosclerosis who becomes pregnant may find that the rate of hearing loss accelerates, Usually the change is not significant enough to cause added concern.

What are the Risks?

The risks are the dangers associated with deafness and the emotional effects of the social isolation that this sometimes produces,

What should be done?

If your hearing deteriorates or you hear ringing in your ears, see your physician, who will examine your ears and probably give you some simple hearing tests, If otosclerosis is suspected, and particularly if you have a blood relative who has the disease, you will probably have to take several special hearing tests.

What is the Treatment?

The only treatment that will halt or cure otosclerosis is an operation called a stapedectomy. A stapedectomy improves hearing significantly in 90 per cent of cases. However, about two to five per cent of these operations result in total deafness in the affected ear. You and your physician should consider this risk as you decide whether you should under­go the procedure. If you have rapidly progressive otosclerosis in both ears, you will probably be advised to have the procedure done immediately to prevent quick onset of total deafness. Usually only one ear is operated on at a time, so that if the operation fails. there is a possibility of a successful operation on the other ear. If the procedure was successful, the second ear may be operated on a year after the first one.

In a stapedectomy, a surgeon folds the eardrum out of the way, removes the diseased stirrup, and replaces it with a tiny metal substitute. The patient usually feels dizzy for a short time after the operation, but can leave the hospital after one or two days. The eardrum heals naturally in one to two weeks. In another two to three weeks, the patient can usually return to normal activities.

In some cases, there is no immediate improvement in hearing after a stapedectomy because a blood clot is left in the middle ear and blocks sound conduction. The clot usually disappears in time and hearing improves.

Like all tumors, those of the outer ear may be either benign (unlikely to spread) or malignant (likely to spread and threaten life).On the visible ear, a benign tumor occurs as a painless wart. In the canal itself, it occurs as a hard growth of underlying bone tissue cal­led an osteoma. With an osteoma, there may be no symptoms at all, or an accumulation of wax, discomfort, and hearing loss.

Malignant tumors on the visible ear occur as warty growths, like benign tumors, or as ulcers or bleeding sores that fail to heal. Malignant tumors are like skin cancer. The cells multiply uncontrollably. They may bleed, and eventually become painful. Malignant tumors in the outer ear canal cause intense earache and bloody drainage.

The dangers of a malignant tumor are the same as those of any malignant growth. If you notice any of the symptoms described, see your physician

What is the Treatment?

Benign tumors can be removed in a minor surgical procedure. Malignant tumors located on the visible ear require either surgery or radiation therapy. During surgery, the tumor and all or part of the visible ear are removed. The operation is sometimes followed by further radiation therapy. Tumors in the canal may require an operation known as a mastoidectomy or temporal bone resection . This operation is followed by radiation therapy.