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Compiled by Shanika Sriyananda

Tinnitus-that annoying noise in the ear

by Dr. W. Ratnayake, Consultant E. N. T. Surgeon

Many of us would have experienced unusual noises in our ears at some time or other which fortunately passes off eventually, but what we may not realise is that there is a large number of people suffering from incurable noises in their ears, disturbing them day and night.

Tinnitus is the medical term for such noises. Temporary noises can arise from conditions such as wax collection in ear canals, inflammation of outer ear or middle ear, ruptured ear drum from trauma and also from stiffness or arthritis of the jaw joint which lies just in front of the ear.

Fortunately, these diseases are curable resulting in complete disappearance of the noises. Tinnitus also arises from certain drugs if taken for a long time eg. aspirin, pain killers given for joint diseases, certain antibiotics etc.

Often, once the drug is discontinued, the noises disappear. In such situations, it is advisable for the patient to inform the doctor about the noises. Sometimes temporary tinnitus occurs after exposure to a loud blast eg. crackers, gun fine, bomb blast.

This usually lasts for a few days only. However, if the blast is severe eg. cracker blast very close to the ear or a bomb blast, permanent damage to the inner ear can occur resulting in permanent tinnitus and often permanent hearing loss.

Causes

Permanent tinnitus is a very disturbing situation for the person having it. There are several causes for this. Most of these affect either the inner ear, the nerve conducting sound stimuli to the brain, and the area in the brain receiving such stimuli. An infection of the inner ear is a common cause of tinnitus.

This is often due to a virus, and rarely due to bacteria. At the initial stages, the patient might sometimes experience dizziness which can even be very severe. This dizziness often settles after a few days but the noises may continue, sometimes with an accompanying hearing loss. Early treatment may reduce the incidence of such permanent problems. Sometimes tinnitus presents without any accompanying evidence of an illness.

Derangement

This is often sudden in onset and may be associated with dizziness and hearing loss. Derangement of the blood supply to the inner ear is thought of as a possible cause in such situations viz. a blood clot or bleeding into the inner ear.

This may be due to the narrowing of blood vessels and increased tendency to clot as seen in diabetes and in those having increased levels of cholesterol and low density lipoproteins. Another cause of tinnitus is a head injury resulting in a fracture of skull close to the inner ear. This causes bleeding into the inner ear, and hence the noises.

A serious cause of tinnitus is a tumour involving the nerve that conducts sound stimuli from the inner ear to the brain. This nerve has two distinct functions i.e. hearing and maintaining the balance or position of the body.

Tumours also may arise from the brain adjacent to this nerve which would eventually press on the nerve. In such tumours, early presenting feature could be tinnitus, and if an early scanning (CT or MRI) is done, the tumour can be detected in its small stages and appropriate treatment given. As the tumour enlarges, the patient develops giddiness and hearing loss.

A large tumour may be difficult to remove. However, it should be emphasised that these tumours are rare, and what is needed is early investigation to exclude such condition.

The common noises that patients notice are the sound of crickets, bellows, wind blowing, sound of the sea, etc.

Sometimes pulsations are heard in the ear, which often tallies with the heart beat. Such noises may be due to increased blood flow around the ear, narrowing of blood vessels in the area and tumours. Often no cause can be found, and the patient needs only regular follow-up to detect any disease that may surface later.

The cause of the tinnitus needs treatment but many do not show an identifiable or treatable cause. The noises are heard louder in the night when there is less outside noise and often sleep is disturbed.

Sometimes, the patient needs sedatives in the initial stages. Creating a noise in the bed room, like keeping a radio on at low volume, having a clock which ticks near the bed, or having any other noise would mask the disturbing noise temporally.

This principle is used in an instrument called a tinnitus masker which can be worn in the ear. It emanates a constant noise which suppresses the tinnitus. Soon, many patients learn to cope up with the noise and manage to disregard it. Others who are not so lucky, get disturbed and depressed, and would need psychotherapy or drugs to elevate the mood.

Tinnitus should not be confused with various noises said to be heard by those who are demented or mentally disturbed. They complain of hearing noises like human voice, drums, chanting of religious stanzas etc. They need psychiatric treatment.

There are Tinnitus organisations in some countries to help the sufferers and to promote research. This shows that a perfect answer is yet to come.

Smoking a leading cause of death

Cont. from last week

by Dr. D. P. Atukorale

Thirty years ago scientific committees and national organisations concluded that exposure to environmental tobacco smoke (also called passive smoking) is a cause of lung cancer. A woman who has never smoked has an estimated 24% greater risk of developing lung cancer if she lives with a smoker.

There is a dose response relation between a non-smoker's risk of getting a lung cancer and the number of cigarettes and years of exposure to the smoker. Tobacco specific carcinogens are found in the blood and serum of non-smokers exposed to environmental tabacco smoke. All the available evidence confirms that exposure to environmental tobacco smoke causes lung cancer.

Heart study

This is prospective study of cardiovascular disease in 7735 men aged 40-49 years selected from 24 towns in England, Wales and Scotland. According to the above study passive smoking is associated with an increase in risk of coronary heart disease (C.H.D.) of 20-25%. Passive smoking may also increase the risk of stroke though information is limited.

According to the above study high concentrations of cotinine (which is a nicotine product) among non-smokers are associated with excess risk of coronary heart disease of about 50-60%.

High overall exposure to passive smoking seems to be associated with a greater excess risk of C.H.D. than partner smoking and widespread in non-smokers that the effects for passive smoking have been under-estimated in the past.

Weight of evidence using serum nicotine concentrations suggests that exposure to passive smoking is a public health hazard and should be minimized.

Smoking and School Students

Among young teens (aged 13 to 15) about one in 5 smokers world wide. Between 80,000 and 100,000 children worldwide start smoking everyday, roughly half of whom live in Asia. Evidence shows that 50% of those who start smoking in adolescence go on to smoke for 15 to 20 years. Peer-reviewed studies show that teenagers are heavily influenced by tobacco advertising.

The number of smokers among school students is still high. There are many factors influencing, these students to start smoking; for example socio-economic status, parents, friends and siblings who smoke and social environment. In developing countries like Sri Lanka smoking among children and adolescents has not yet received much attention.

It has been found that the most common age for starting smoking was between 15 years and 19 years. The main sources of the first cigarette were relative or neighbour (25% school friend (18.9%)). Close relative i.e. father or sibling accounted for 20.9%, and friend outside school (18.9%).

The first cigarette for those who smoked before 10 years of age was predominantly given by a relative or neighbour followed by close relatives (mainly father). For those who started smoking between 10 years and 14 years the main sources were relatives or neighbours, school friend or close relative (father or sibling).

For those who smoked between 15 years and 19 years the main sources were friends outside school or school friends. The first cigarette was usually smoked at home, followed by on the way to or from school and these at the house of a friend or relative.

The reason for starting smoking was usually to see what it was like i.e. curiosity followed by to imitate others and because of encouragement by others. The idea that smoking makes people elegant was not a common reason given for starting smoking.

Health

Currently there are more than 70 countries in the world which have official anti-smoking programs and activities including campaigns to protect individuals from tobacco smokers and promoting a healthy environment.

Work environments and other public places should be tobacco smoke free in order to reduce the adverse effects on peoples' health. In this respect we should appreciate the good work done by Minister of Health and Nutrition to make our hospitals and Ministry of Health and Nutrition smoke-free areas.

Half of long-term smokers will die from ill-effects of tobacco.

Every cigarette smoked cuts at least 5 minutes of life on average- but the time taken to smoke it. Smoking is the single largest preventable cause of disease and premature death. It is a prime factor in heart diseases, stroke and chronic lung diseases including lung cancer.

More than 4000 toxic or carcinogenic chemicals have been found in tobacco smoke.Smoking related diseases cost the United States more than 150 billion US$ a year. Smoking is mainly a problem of young and adult males in Sri Lanka. Fortunately smoking is rare among females in our society. It is likely that social norms and traditions have a greater influence on females than males in our society.

The most cost - effective strategies are population wide public policies like bans on direct and indirect tobacco advertising, increase on tobacco tax, smoke free environments in public and work places and large clear graphic health messages on tobacco packaging. Anti-smoking campaign should be started in our schools. Cigarette smoking and advertising of cigarette should be banned in all Big Matches as these are school events and not adult events.

Eye for excellence : Chennai hospital designs world's smallest needle

"Despite the reduced incision loop, the operating time for cataract is under five minutes." Chennai: Ever since the phaco procedures, featuring surgical incisions of barely 3mm to remove the cataract mass, arrived in the 70s, the area of incision employed to correct the leading cause of blindness in the country has been shrinking.

Now a leading private ophthalmic hospital in Chennai has designed a 0.7mm phaco needle tip that works in tandem with a matching 'irrigating chopper' to provide ophthalmologists the smallest tools for cataract surgery.

Billed as the world's smallest needle in a recent issue of Eye World, a publication of the American Society of Cataract and Refractive Surgery, the micro incision surgery (Microphakonit) has been pioneered by Dr. Agarwal's Eye Hospital. Microphakonit is basically an improvement on the 1mm Phakonit (needle incision technology) developed by the hospital in 1998.

"Despite the reduced incision loop, the operating time for cataract is under five minutes for a skilled hand," says hospital director Amar Agarval.

Microphakonit is particularly useful in performing procedures like vitrectomy to clear blood/debris from the eye or alleviate traction when there is pressure build-up in the operating region.

The smaller the incision, the lesser is the risk of infection. There is no scarring and patients seldom require hospitalisation. -Hindu.

Holistic healing - Herbal Care for asthma

by Dr. Danister L. Perera

Pippali (Piper longum) is a powerful stimulant to both the digestive and respiratory systems. It removes cold with congestion and can help with chronic lung diseases like asthma.

According to Ayurvedic tradition, Pippali possesses stimulating, carminative, expectorating, tonic, aphrodisiac, diuretic, alterative, emmenagogue, and analgesic properties, and is traditionally used to treat cold-wet diseases such as bronchitis, cough, cold, hoarseness, hiccup, laryngitis, respiratory problems, asthma, gout, arthritis, rheumatism, nausea, catarrh, worms, flatulence, indigestion, and dyspepsia. Also known as the "Long Pepper," it removes cold and obstructions from the liver and spleen and helps dispel abdominal tumours. It is also used in post partum conditions to ward off fever, and is applied topically as an oil in sciatica.

According to Ayurveda, Licorice root is tonic, cooling, demulcent, expectorant, emmenagogue, and a gentle laxative. Some sources call it diuretic, but it is properly understood as an anti-diuretic, hence it should be avoided in cases of high blood pressure (hypertension).

It is a nerve tonic with energy enhancing properties effecting the adrenal glands. Licorice is also an anti-inflammatory, and Ayurvedic tradition holds it to be having an influence on the mind, voice, and vision. Large doses are emetic.

Other Ayurvedic uses of Licorice, also known as "yashti madhu," are the treatment of scorpion sting, ulcers, malaria, catarrh of the genito-urinary tract, spleen problems, dysuria, hyperacidity and painful urination.

More typically it is used with other herbs as a synergistic harmonizing factor, assisting greatly in the management of almost any condition involving the liver, lungs, bowels, and blood. It is a common ingredient in cough formulas, helping with hoarseness, sore throat, inflamed bronchial tubes, asthma, fevers, laryngitis, and colds. Licorice is a pre-eminent female remedy, useful in leucorrhea and general uterine complaints. It also reduces thirst, and helps the hair and complexion.

Basil is a stimulating diaphoretic and carminative. The leaves are especially fragrant and aromatic, possessing antihelminitc properties. The juice of the leaves is dropped into the ear to treat earache and dullness of hearing. Additionally, Tulsi is a febrifuge and a nervine antispasmodic, and is a significantly strong antiseptic and antibacterial.

It is used internally for many conditions, such as asthma, cough, colds, sinus congestion, and headaches. In nasal myosis it acts as a parasiticide. Other cases in which Basil is used are rheumatism, arthritis, and abdominal distension. Recent research indicates Basil helps control blood sugar levels in diabetics.

Tulsi is a sacred plant, capable of opening the heart and mind, clearing the aura, strengthening faith, love, and devotion. It is known as the "the semen of Shiva," and it both absorbs positive ions and energizes negative ions, and also liberates ozone from the sun's rays. Basil removes excess "Kapha" from the lungs and nasal passages, induces clarity, and removes high Vata from the colon.

The seed is also a mucilaginous demulcent, with diuretic properties, reputed to be an aphrodisiac, used primarily to treat catarrh, chronic diarrhoea, dysentery, gonorrhoea, nephritis, cystitis, internal piles, and pains following parturition.

Vacha or Vadakaha is a herb which stimulates nervine antispasmodic activity, and a general tonic to the mind. As a rejuvenation for the brain and nervous system, it is used to promote cerebral circulation, to stimulate self-expression, and to help manage a wide range of symptoms in the head, including neuralgia, epilepsy, memory loss, coma, shock, deafness, nasal congestion, polyps, sinusitis, sinus headaches, and headaches in general, where it is usually applied externally.

In many cases involving the sinuses or shock and coma, the powdered root is taken nasally. Vacha, also known as "Sweet Flag," possesses expectorant, decongestant, and emetic properties which make it useful in the treatment of several conditions.

Combined with Licorice root it is used against coughs, colds, fevers, asthma, and capillary bronchitis. When Vacha is chewed it produces copious salivation and helps irritated throats. It clears the subtle channels of toxins, and acts as an antidote to several poisons.

It also helps to manage arthritis, dyspepsia, loss of appetite, choleraic diarrhoea of children, and is used as an insecticide to keep moths and flies away. It is used with great caution in bleeding disorders.

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