Dr Sonia's ENT

ENT Specialist, Head & Neck Surgeon,Bangalore
Dr Sonia Suprabha Venugopal

ENT Health Articles

Health articles on ENT ,Head and Neck Diseases, Conditions and General articles by ENT Surgeon,Head and Neck Specialist Dr Sonia Suprabha Venugopal

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Nose Block Slideshow

Posted on January 20, 2011 at 12:33 PM

This is a slideshow about the common condition Nose Block.

It is best viewed as a full screen presentation.Click on the menu button at the bottom left hand corner and click full screen for a good visual.

Fluid in the Ear

Posted on January 15, 2011 at 9:45 AM

You need Adobe Flash Player to view this content.

The animation shows the different parts of the ear :

Outer ear

Middle ear and

Inner Ear.

It shows how the normal ear functions and sound is heard by us.

When the eustachian tube is affected due to inflammation or obstruction fluid can accumulate in the middle ear. This can happen suddenly or slowly over time.In acute cases as following a cold bacterial infection leads to the condition called ASOM or Acute suppurative Otitis media which is a painful condition requiring treatment.This often resovles well with therapy and rarely only requires more advacned treatements.In NSOM or Nonsuppurative Otitis media or Glue  ear the fluid is often viscous and due to the dysfunction eustachian tube the fluid does not resorb by itslef and may require a myringotomy grommet as depicted in the animation.The purpose of this procedure is to drain the fluid and restore ventillation to the middle ear and to restore the normal hearing mechanism.


Dr Sonia Suprabha Venugopal

Consultant ENT and Head and Neck Surgery



How to Give Medicines to Kids

Posted on January 15, 2011 at 9:45 AM

•DO NOT give adult medicines to kids

•Some medicines are not safe for kids- so DO NOT self medicate kids

•DO NOT guess the dose of medicne to give: in case of over the counter medicines do not guess how much to give- always consult your doctor.

•Know what key ingedients the medicine contains :many combination medicines contain more than one drug and if you are giving 2 or more medicines you may overdose your child-READ LABELS CAREFULLY

•Know your child's weight: doctors often dose your child according to weight

•Know the correct medine strength to use [ mg/milligrams/ml or tablet strength]:The same medicine can come in different strengths for infants[ below 1 year],kids and adults and double strength - be clear on the dose strenght of the medicine so as not to overdose your child

•Use measuring tools accurately:The kitchen spoon is not an accurate dosing tool.Either use the measuring tool provided with the medication or use a medicine dropper or marked medicine spoon available in the market.

•Check the expiry date of any medicine you buy/ have at home

•How to store medicines: some powder medicines which have to be made into liquid need to be stored in the fridge- Follow Storage Instructions on the labels carefully.Avoid storing medicines at high temperature, humid places.

•Store medicines away from children- many medicines are tasty and children may poison themselves.

•Always tightly screw the cap of bottled medicines

•Shake liquid medicines well before giving to children

•DO not tell your children medicines are candy or toffee - this is to prevent accidental ingestion by the child if he or she gets access to them by mistake


•Relation of medicines to food: Follow your doctor's instruction on whether to give the medicine before or after food.

•Infrom your doctor if the child is taking any regular medicines

•Always report if any adverse reaction occurs to any medicines- do not continue to give that particular medicine without consulting your doctor

•Always keep a note of your child's allergies and inform the doctor and nurse about it at all times

•Get to know your child's preferences:nowadays some medicines are available in chewable tablets/ syrups etc

•Follow dose strengths[amount to be given] and dosing frequency[how frequently to give] accurately -this is very important for both symptomatic relief and cure of the condition

•Complete the course of medicines: your child may get better but your doctor may have advised medicines for a particular duration- this is to ensure complete cure of the disease pathology

•Clarify all instructions about SOS medicines - ask your docotr clearly what is the maximum number of times/ amount that can be given to your child

•If your child is not getting better do inform the doctor and get your child re-evaualted

•And above all remember Children are not small adults - they require different types of medicines and different dosings.

Impact of GERD or Acid Reflux or LPR

Posted on January 15, 2011 at 9:45 AM

What is GERD or LPR?

GERD means Gastro-oesophageal Reflux Disease - Here acid from the stomach refluxes back into the fod pipe[ oesophagus] and produces the common symptom of heartburn which all of us have experienced at one time or the other

LPR means Laryngo-pharyngeal Reflux- Here acid from the stomach refluxes back into the fod pipe[ oesophagus] and even rises upto the throat. The lining of the throat and upper airways is more sensitive to acid than the tougher oesophagus and hence can produce various disease conditions.

Diseases due to Laryngo-pharyngeal Reflux

  • Esophagitis [inflammation of th efood pipe can lead to ulcers and even strictures]
  • Cough- long standing or recalcitrant cough can be due to LPR
  • Asthma-asthma can worsen with LPR
  • Pharyngitis- throat lining can become inflamed due to contact with the stomach acid contents and become a chronic or recurrent throat pain.It can alos give rise to increased throat secretions
  • Laryngeal Inflammation- the voice box lining is especially sensitive to acid contact and can produce swelling , voice change  and LPR has even been implicated in cancer of the Voice box in various scietific studies.
  • Inflammation and infection of the lungs
  • Sinusitis
  • Middle ear afflictions - this can occur due to the eustachain tube that leads from the back of the nasopharynx to the middle ear.This is an important issue in children.
  • Barrett's esophagus- is a precancerous condition of the food pipe[oesophagus]

Ear drum perforation- causes,symptoms,line of action

Posted on July 27, 2010 at 12:19 AM

Ear drum perforation- causes,symptoms,line of action

By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

The ear drum is a thin delicate membranous structure situated deep within the ear canal and separates the outer ear canal from the delicate middle and inner ear.Due to its delicate nature the ear drum can get ruptured by various causes even a slpa on the ear can rupture the ear drum.

See Article on Ear drum-What is the ear drum?

What are the causes of an ear drum perforation[ ear drum hole]?

  • Middle ear infection
  • Eustachian tube dysfunction[ the eustachian tube is a tube which connects the middle ear with the nasopharynx[back of the nose]The picture below shows diagramatically how the eustachian tube connects the middle ear and the nose.
  • Injury- slap ,fall on the side of the head,injury with ear buds[See Article on Ear bUds and You ,injury with sharp objects inserted into ear,sports injury,motor vehicle accidents,head injury can injure the ear drum and produce an ear drum hole
  • Lightning injury
  • Very loud sound Blast waves from gunshots, fireworks, explosions can produce an ear drum perforation
  • Pressure changes- such as in diving or air travel can injure and rupture the ear drum due to pressure inequalisation between the middle ear and the external ear canal

Can the ear drum perforate due to a cold[upper respiratory tract infection]?

Yes it can!

During a heavy or prolonged "cold ",infection can be transmitted to the middle ear from the nose via the eustachian tube .Fluid collects in the middle ear and since the middle ear is enclosed in a narrow bony crevice fluid build up in the narrow area stretches the ear drum which can easily burst at the peak of fluid accumulation.The ear drum perforation is preceeded by ear pain and the perforation can even releive the pain to some extent as the fluid build up is released.This may give the patient a false impression that all is well but tell tale signs are-

  • Bleeding due to the rupture of the ear drum [ this may be anly a few drops or as a blood stained ear discharge ],
  • Hearing loss[may be mild as to be unnoticeable .

Other symptoms which may or may not be present in ear drum perforation are

  • Tinnitus
  • Dizziness
  • Imbalance mild
  • Spinning sensation[vertigo]
  • Ear fullness

If there is severe middle ear infection also the ear drum can perforate due to pus accumulationin the middle ear which can put presure on the ear drum, thin the ear drum and perforate it.

What are the signs and symptoms of an Ear drum perforation due to injury?

A slap or fall on the side of the can produce an ear drum perforation.Symptoms in such cases :-

  • Ear discomfort
  • Ear pain[need not be present]
  • Ear fullness
  • Hearing loss [may not be noticeable sometimes]
  • Tinnitus [sounds in the ear]
  • Ear discharge [blood stained ]- very mild as to be unnoticeable often
  • Bleeding - usually only a few drops

What are the symptoms of an old ear drum perforation?

You may be having an ear drum perforation for sometime [mostly due to previous ear infection which has not healed]- what are the symptoms in such a case?

  • Ear discharge on and off - especially when there is a 'cold'[upper respiratory infection] or there is some water entry into the ear
  • Hearing loss [ often denied and goes unnoticed as the other ear if normal makes up for the Hearing loss ]
  • Tinnitus [may or may not be present]
  • Dizziness [may come and go]

What is to be done in a old ear drum hole?

You need to meet an ENT Specialist and get your ears evaluated.In the presence of an ear drum perforation not only can the hearing deteriorate but there is always a risk of serious infection.Sometimes if the ear drum perforation is small medical ear drum closure is possible with special direct otoendoscopic medication application.Sutureless ear drum surgery is a sophisticated daycare procedure which can be performed with ease by an ENT specialist with specialised qualification in the same.

What is to be done if you suspect an ear drum perforation[recent] in yourself or your child?

Do not let water enter the ears till your suspicions are cleared

Do not put oil or other liquids into the ear canals

Continue all cold medications you or your child is already taking

Visit your ENT Doctor at the earliest as timely treatment gives the best results and prevents complications.


Dr Sonia Suprabha Venugopal

Consultant ENT and Head and Neck Surgery

Dr Sonia & Dr Prateek's ENT ,Head & Neck Center



Ear Piercing

Posted on July 16, 2010 at 11:17 PM

Ear piercing ,nose piercing and for that matter piercing of any part of the body has to be done with the utmost care and sterile precaution.

Traditional practise in India was to get the family jeweller to pierce the baby's ear amidst much fanfare and celebration.Nowadays with awareness of the risks involved people are gravitating towards more scientific and safer approaches in ear piercing and nose piercing.

How do I decide where, when and how to do a ear piercing?

Since getting your or your child's ear pierced is something which is undertaken after much deliberation and thought it is nice to have some inside knowledge about the trends, methods and risks involved in such a procedure.

When should an ear piercing be done?

Here are some key points to guide you when to have an ear piercing done.

  • Children should not have their ear pierced on a day when they are sick or having fever.
  • Do not pierce your or your child's ears during the time of any rashes on the skin
  • Avoid clubbing a vaccination and an ear piercing on the same day
  • Do not pierce the ears at the time of an outer ear infection- always get specific clearance from your ENT Specialist in such a case
  • Traditional customs: In India many customs dictate a specific time or "muhurtham" for an ear piercing and we get many patients requesting for piercing the child's ear at such and such a time- In case of any such specific timings do contact Dr Sonia in advance so that scheduling can be done accordingly.
  • Age:There is no particular age for the ear piercing to be done.Anyone from birth to 99years and beyond can have their ears pierced.

Where should an ear piercing be done?

Even nowadays I see ear piercing being done on the streets [even in the streets of Bangalore our Hitech City !] in India.

Ideally it should be done in the aseptic and clean environs of a doctor's procedure room by a qualified medical personnel who is well versed in the techniques of disinfection and sterile techniques.

Doctors recommendation is to get your ear pierced by a qualified doctor.

Which speciality doctor should do the ear piercing?

ENT Surgeons are most experienced in this respect and the obvious answer is to have your or your child's ears pierced by the ENT Doctor

However some pediatricians are experienced in this respect and if your regular Pediatrician does ear piercing on a routine basis there is no harm in having your childs ears pierced by him or her

Tradition plays a big role especially in a tradtional culture such as the Indian one- your grandmother may recommend the famliy jeweller but before humouring her do give careful consideration to the risks you are putting your child into.

We do not recommend ear piercing in

  • the beauty parlour[ most beauty parlours do not have sterilising or disinfecting equipment and are not familiar or aware of proper sterilisation techniques]
  • jewellery shops [face it the jewellers role is to sell ear rings, nose rings etc and will not have the knowledge or the facilities for disinfection and aseptic techniques]
  • Streets-NEVER NEVER have an ear piercing on the street or local mall shop!- there are upteem number of diseases you can pick up from  infection to tetanus, Hepatitis B,Hepatitis C and HIV[AIDS]

Many ear piercings done in beauty parlours,jewellery shops go without complications but a good % do end up in the ENT doctor's consultation room subsequently with infection as a result of ear piercing in such a set up.

How is ear piercing done ?

There are 2 main methods of ear piercing

  • Manual Piercing - this is a more painful ,bloodier affair and hardly recommended in the modern ENT Surgeon's practise
  • Automated Gunshot Piercing-This is the easiest,quickest and modern techinique popular nowadays.It is the method of choice in adults and children due to its efficiency and safety.

Various types of gun shot body piercing devices are available. Pediatric as well as adult attachments and a variety of ear studs  choices are available.

You do not have to bring the ear rings from home as sterile specially designed ear rings are used in the ear piercing.Your ENT Doctor will show you a selection of earrings and you may choose the one to your liking.Dr Sonia recommends that if your child is old enough to allow her to choose the ear ring or nose ring as it gives the child a lot of happiness!

A local anaesthetic cream may have been prescribed by Dr Sonia for application some time before th procedure for a completely painless ear piercing.

The ear piercing site is decided upon in consultation with the ENT Doctor

The area to be pierced is disinfected

A local anaesthetic spray is used to anaesthetise to skin

Your child may be comfortable seated on your lap.

Young children and babies are held immobile to ensure acurate positioning of the ear ring

The Gun shot device is loaded  with the  ear ring by the Doctor

Ear piercing is done in a fraction of a second in a precise, controlled ,aseptic and painless manner

What other points should I know about ear piercing?

  • If you have an allergy to metals discuss this with your ENT Doctor before hand
  • If your child suffers from atopic dermatitis or eczema or atopy [allergic tendency]discuss with Dr Sonia the special care involved in such a case
  • It is best to be up to date on your tetanus injections before any procedure [This is being mentioned here to create a health awareness about the general health measures]
  • Always mention to your ENT Doctor if you have any knowm allergy to any medications
  • If you are having your ear pierced after a lobuloplasty [ear lobe repair for torn ear lobe or large ear ring hole]discuss with Dr Sonia the best site to have the new ear ring placed

What should I do to have my Baby's or child's ear pierced?

In addition to the above discussio,n additional points once you have set a date for the ear piercing:-

  • Have an appointment with the ENT Doctor- Choose a time when the doctor is less busy and you are not rushed for time-this ensures an overall relaxed attitude
  • Avoid having a hungry, angry baby at the time of ear piercing- there is no contraindication to feeding your baby or child before the procedure
  • Have your baby dressed in comfortable clothes
  • Bring along a favourite toy
  • Explain to your older child what is going to be done so that your child knows what to expect and is not unduly anxious.You may explain she is going to look pretty and beautiful and that the actual ear piercing will be felt like a small ant bite.Explain that she or he has to stay still and that it takes only a few seconds.
  • Have an idea of where you want the ear ring placed- there is a lot of variation in individual desires.Someone may want it in the centre, someone may want it higher up or lower in the ear lobule. Some people like to have multiple ear rings on the helix of the ear[ rim of the ear is a popular site for 2nd 3rd and 4th ear rings].Though many times our ears are not strictly similar in shape and size it is nice to pay some attention to symmetrical positioning of the ear rings- so give this some thought when marking out the site.Your ENT Surgeon can guide you in deciding the spot to pierce the ears
  • Clear any doubts you may have [eg if your child has atopy, allergy,fever, a vaccination scheduled etc]

Can my child or myself wear our own ear rings?

Yes you can wear your own ear rings 2 weeks after the ear piercing. It is preferable to wear a gold ear ring if this is a first time ear piercing so as to ensure no metal allergic reaction occurs.

What are the precautions after ear piercing?

Do not use dettol or strong detergents to clean the ears

Gently apply the medicated ointment prescribed by Dr Sonia as advised

Rotate the earring every day as instructed by Dr Sonia

Change to a normal, preferably gold ear ring after 2 weeks

Changing is easy and can be done after 2 weeks.In young babies you may change the ear ring when the baby is sleeping to make is easier and quicker.

The ear ring used should be clean and changed with clean hands.

Do not remove the ear  ring and leave the hole open before 2 weeks as there is chance that the hole can close up.

Do not use broom sticks or other sticks in the ear ring hole.

Contact Dr Sonia in case of any doubt or clarification

What is Acid Reflux?

Posted on July 13, 2010 at 11:43 PM

By Dr Sonia Suprabha Venugopal,ENT Surgeon,Head and Neck Specialist,Bangalore

To understand what is meant by acid reflux I shall first explain to you what  normally occurs in the body

What happens to the food we eat?

When we eat food  it is broken into small bits in the mouth and the initial stages of digestion start by the action of the  salivary enzymes in the mouth itslef.When we swallow food, food passes down the throat,into the food pipe[ oesophagus] and reaches the stomach.There the food is digested and passes onto the small and large intestine where further digestion and absortion takes place.Finally undigested and waste material is voided from the body.
Ever wondered why food does not come up the food pipe normally?

There is a normal peristaltic movement which propels food in a forward movement down our digestive tract.There is an important sphincter in the food pipe which monitors the passage of food through the food pipe.There is an upper oesophageal sphincter at the top entrance of the food pipe[ oesophagus] and also a very important lower oesophageal sphincter at the lower end of the oesophagus controlling food entry and preventing reflux of stomach contents back into the food pipe.This is the normal situation.

What is acid reflux?

Acid reflux is a condition wherein the stomach contents including partially digested substances, stomach acid, stomach secretion and  digestive enzymes reflux up from the stomach into the food pipe[oesophagus]

What is the importance of acid reflux?

In the past few decades scientific advances and research has implicated the ubiquitous "Acid reflux" as the culprit in producing a significant number of diseases and conditions in the upper respiratory tract with impact on the ear,nose,throat , voice box and even the lungs!

How is an ENT Surgeon involved in Acid reflux diseases?

There are 2 distinct type of acid reflux diseases:-

Gastroesophageal reflux disease[GERD] - here acid refluxes only into the oesophagus[foodpipe]


Laryngopharyngeal reflux [LPR]- here acid refluxes even beyond the food pipe and affects the throat, nose,nasopharynx, sinuses,ears,voice box and even the lungs.

The Gastroesophageal reflux disease[GERD] produces symptoms we comonly experience  such as heart burn,stomach discomfort.This is what we refer to as "acidity" or "gas" problem.

Laryngopharyngeal reflux disease has more subtle and varied symptoms as the effect of the acid reflux can be in the nose,sinuses, throat , ears or voicebox .The patient and often the general physician does not realise the presence of the acid reflux or the significant causative role it plays in the current symptoms the patient has.Here lies the role of the experienced ENT,Head and Neck Surgeon.

How does the ENT Surgeon diagnose Laryngopharyngel reflux?

The ENT Surgeon wil take a detailed history specific for acid reflux disorder ,look for predisposing factors in your diet and lifestyle and perform a complete head and neck examination. An endoscopic examination in the ENT doctor's consultation room will provide valuable diagnostic insights into the disease and its severity.
Dr Sonia usually does a laryngopharyngoscopic examination in the docotr's consultation room itslef to look for evidence of Laryngopharyngeal reflux.

Other optional investigations include:-

A nasopharyngoscopy

A nasal endoscopy

An Otoendoscopy

All these are simple procedures which in expert hands can quickly help arrive at a diagnosis and management strategy.

Imaging studies and endoscopy of the oesophagus and stomach  and direct laryngoscopy and hypopharyngoscopy may be advised depending on the individual case.

What is a DNS [Deviated Nasal Septum]?

Posted on July 13, 2010 at 12:18 AM

What is the Nasal Septum?

The nasal septum is a composite plate like structure made up of membrane,bone and cartilage.The nasal septum divides the two halves of the nose into right and left nasal cavities.

What is a DNS or Deviated Nasal Septum?

If the nasal septum which is ideally central, is deviated to one side or the other ,ENT Specialists refer to this as a deviated nasal septum or DNS for short.

Why does a DNS occur?

This is a question very commonly asked by my patients.

A DNS can be developmental in origin - it can bend over timeor the cause may be trauma such as a hit or an accident.

What are the types of DNS?

ENT Doctors describe a deviated septum based on the shape of the devaition,parts of the septum deviated and location of the deviation.So you may be having:

A C shaped deviation-Here the septumis bent in a C shaped manner producing narrowing of the airway onone side

S shaped deviation- produces airway narrowingin both the nasl cavities and can make the person prone to become symptomatic easily

A bony, cartilaginous or mixed type deviation

A high DNS[ upper part of the septumis deviated and this may even be associated with external nose shape deviation which can be  noticeable to the patient and others fromt he outside]

A caudal dislocation[front most part is deviated]- often a smart patient comes to me after noticing the deviationof the septum in the mirror! Many a times such cases of DNS are caudal deviations and can be self diagnosed by lifting up the tip of the nose and looking in the mirror to see if any part of the nasl septum is protruding into the nasal cavity on one side and narrowing the airway on one side!

The photo shown is a patient with significant caudal dislocation of the nasal septum

Will my DNS create problems for me?

Not everyone with a deviated nasal seputm has symptoms due to it.Whether a deviated nasal septum will create problems depends on:-

  • Severity of the deviation
  • presence of additional Turbinate hypertrophy narrowing the nasal cavities further
  • Shape of the deviation
  • Allergic tendency- if you have allergic rhinits then the nasl septal deviation can contribute significantly to the problem and correcting the deviation can help the nasal obstruction symptoms to a certain extent depending on the individual case.

What are the problems caused by a deviated nasal septum?

A  DNS can cause a variety of problems for an individual.The symptoms need not be present all the time and can develop any time in due course.

  • Nasal Block
  • Nasal discharge
  • Nose bleeds
  • Post nasal discharge[PND]- secretions dripping into the throat fromt the back of the nose
  • Snoring
  • Mouth breathing
  • Taste and Smell abnormalities
  • Sleep Apnoea
  • Dry mouth
  • Recurrent Throat infections- from abnormal drainage of secretions into the throat and mouth breathing
  • Recurrent Sinusitis
  • Recurrent Upper Respiratory Infections
  • Ear problems- by affecting the eusatchian tube connecting the ears and the back of the nose.

What is the treatment for a deviated nasal septum?

Treatment is tailored based on:-

  • Severity of the DNS
  • Symptoms of the patient
  • Age of the patient
  • Presence of additional conditions in the nose:
  • Turbinate hypertrophy
  • Concha bullosa
  • Chronic Sinusitis
  • Allergic boggy mucosa
  • Nasal polyps

A nasal endoscopy is a prerequisite for any treatment decisiona as it gives a direct visualisation of the nooks and crannies of the nose, the levels of nasal obstruction andthe precise location of the abnormal septal deviation.Your ENT Surgeon will perform a nasl endocopy and discuss the treatment options with you.

Someimes an additional CT scan is required to further evaluate the sinuses and tailor the managament of an individual patient.

Treatment options are broadly divided into

Conservative medical management


Surgical management

What is the Surgery for the Nasal Septum Deviation?

The Surgery for a nasal septal deviation is a Nasal Septal Procedure.There are a variety of nasal procedures done in a patient with nasal septal deviation depending on the individual case.Dr Sonia will discuss which is best suited for  you.

  • Conventional Septoplasty
  • Nasal Spurectomy
  • Endoscopic Septoplasty
  • Endoscopic Septoplasty + Endoscopic Sinus Surgery
  • Endoscopic Septoplasty + Turbinate Procedure
  • Endsocopic Septoplasty + FEELS [Functional endocospic endonasal LASER Surgery]
  • Septorhinoplasty [ correction of the external shape as well

Surgery may be performed under local anaesthesia or general anaesthesia.Dr Sonia prefers to use general anaesthesia in majority of the cases as it gives optimum comfort to the patient.The patient is completely asleep during the procedure and there will be no pain during the surgery at all in general anesthesia.

When can I go home after the procedure?

Generally speaking you can go home the same day or the next day depending on the individual situation.

Will there be a scar on my nose after the surgery?

The surgery is done through the inside of the nose and there will be no scar or stitches on the face or outer part of the nose.

In case of any further clarification contact your ENT Surgeon

or feel free to post a comment below this post

Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Dr Sonia & Dr Prateek's ENT ,head and Neck Center,Sahakaranagar, Bangalore




ENT Specialist Bangalore


Understand your CT Scan

Posted on July 6, 2010 at 4:31 AM

By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

Your ENT Doctor may have ordered a CT Scan of the siuses for some reason. Shown is a labelled animation of the CT scan of one of my patients depicting normal as well as abnormal structures.

Shown is the CT scan of the Nose and Sinuses

The scan shows


Nasal septum- a bony- crtilaginous structure that divides the 2 halves of the nose

maxillary sinuses-are air filled sinuses[ black in colour if normal]on either side of the nose

Ethmoid Sinuses- located between the eyes in the upper part  of the nose

&Turbinates-The turbinates are fleshy masses on either side of the nose.There are 3 pairs of turbnates- superior,middle and inferior.

Abnormalities in this CT Scan:

In this particular patient there is enlargement[ hyprtrophy] of the iferior turbinates on both sides producing nose block

The middle turbinates are also abnormal - they are curved in an abnormal direction and are termed paradoxical middle turbinates.

The nasal septum which divides the 2 halves of the nose has a prominent abnormality called a nasal septal spur which is a projection of the septum in an abnormal fashion.This can produce narrowing of the air passages, turbulence of air flow and contact with the turbinates. This can produce various effects such as:-

Nose block

Nose bleeds [Epistaxis]


Facial pain

This patient underwent successful endoscopic septoplasty and endoscopic turbinate surgery.


Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore





Posted on July 6, 2010 at 4:22 AM

By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

What is meant by adenoids?

Everyone has heard about tonsils, but what are adenoids?

You can easily see your tonsils, but where are the adenoids?

Adenoids are lumps of spongy lymphatic tissue situated right at the back of the nose at the roof of the mouth. You may be able to see your tonsils by standing in front of the mirror and opening your mouth wide but adenoids are not so easily visible. ENT Specialists use special mirrors and endoscopes to visualize the adenoids. Adenoids are present from birth and can gradually increase in size to produce problems in children. It has mostly disappeared by the time your child is a teenager and for that matter adenoid problems are seen in children only.

Why does the adenoid enlarge?

Increase in size of the adenoid can occur on its own or due to inflammation [infection, allergy]

What are the effects of enlarged adenoids?

Since the adenoids are situated in the back of the nose and close to the orifice of the eustachian tube, adenoid hypertrophy or enlargement can have effects on the adjoining areas :-

  • Ear
  • Nose
  • Sinuses
  • Throat

Effect on Ear: The eustachian tube connects the middle ear to the nasopharynx [ back of the nose] and eustachian tube dysfunction can occur when there is adenoidal enlargement or when the adenoids are a seat of chronic infection. Eustachain tube dysfunction can lead to ear infection in children and fluid collection in the middle ear called glue ear. Fluid in the ear can produce hearing loss, ear discomfort, dizziness, tinnitus, aural fullness etc

Effect on the Nose and Sinuses: A large adenoids can block the back of the nose [called choanae] and produce nose block, nose congestion, collection of secretions, and increased nasal and sinus infections.

Effect on the Mouth and Throat: Enlarged adenoids produce mouth breathing in the child as a result of the nose block. Initially this may be only at night and parents will notice the child snoring .It is not normal for children to snore! In severe enlargement of the adenoids the child will breathe through the mouth in the day time also. Mouth breathing can affect the dentition of the child in an adverse way. When a child breathes in air through the mouth the important filtering and humidifying action of the nasally breathed air is lost and this predisposes the child to more frequent throat infections.

Effect on sleep and health: Since adenoids affect the normal breathing and this is more pronounced at night, sleep of the child may be affected with adverse effects on growth. In Sever cases sleep apnea can develop with serious effects on the lungs and even heart.

Could my child be suffering from adenoids?

Your child may be having an adenoids problem if your child is suffering from:-


  • Frequent upper respiratory infection
  • Persistent or frequent running nose
  • Frequent cough
  • Frequent or persistent nose block
  • Mouth breathing at night
  • Open mouth posture in daytime
  • Snoring
  • Frequent ear infections
  • Recalcitrant ear fluid

More subtle effects of adenoids which are often not noticed by parents include:-

  • Swollen glands in the neck
  • Bad breath
  • Dry mouth
  • Restlessness while sleeping
  • Cracked lips

What are the complications of adenoids?

Since adenoids affect the breathing of the child and can also affect the ears, untreated it can have dangerous health consequences.

Enlarged untreated adenoids can produce

Ear infections

Ear Fluid

Hearing loss due to ear affliction


Recurrent Tonsillitis

Recurrent Pharyngitis[Throat infections]

Behavioral problems

Sleep apnea

Pulmonary Hypertension

Right Sided Heart Failure

How is adenoids diagnosed?

Clinical Suspicion and Consultation

The layman’s knowledge about the adenoids is quite dismal in majority of the cases and even though you as a parent are concerned about your child’s health ready and reliable information about health and diseases is hard to come by! Since the signs and symptoms of adenoids are so ubiquitous often the general physician or pediatrician may fail to think about adenoids and it is indeed the astute clinician who suspects the condition and makes a timely diagnosis in your child. Regarding the adenoids the adage Out of Sight, out of mind holds true .Awareness about the condition and being well informed can help you safeguard your child’s health against this common childhood condition.

Your Pediatrician may suspect adenoids if your child is suffering from

Frequent colds

Frequent Cough

Post nasal drip

Mouth breathing

Ear infections

Fluid in the ear


Your pediatrician will refer you to an ENT Specialist who will take a detailed history and examine your child

Examination and tests

Your ENT Specialist can diagnose adenoids by examining your child.

Adenoids can by diagnosed by

  • Post nasal Mirror examination
  • Nasal Endoscopy
  • X-rays

If your child is cooperative a painless quick nasal endoscopy may be all that is required to clinch the diagnosis

Dr Sonia uses a real time video endoscope to visualize the adenoids situated at the back of the nose. Using endoscopy one can judge the presence of the adenoids, the amount of blockage produced by the adenoids and also assess for other contributing conditions in the nose such as turbinate hypertrophy, allergic mucosal swelling, nasal polyps, and deviated nasal septum. Using endoscopy we can even avoid taking an X-ray many a times.

Sometimes your child may require an X-ray of the Nasopharynx [area behind the nose where the adenoids are situated] to assess the presence and severity of adenoids.

An otoendoscope or otoscope is used by Dr Sonia to examine the ears: this will reveal the condition of the ear drum and the middle ear. Children with adenoid enlargement can have fluid in the middle ear and in long standing cases ear drum affliction in the form of retraction of the ear drum.

Hearing and Middle ear function Tests: These tests are simple tests ordered if there is suspicion of ear involvement in your child. In the young child even a mild hearing reduction can have severe consequences hence the need to promptly assess and treat such conditions.

How are adenoids treated?

Treatment of adenoids takes into consideration a constellation of clinical factors including

  • Child’s age
  • Symptom of the individual child
  • Duration of symptoms
  • Previous treatment history
  • Presence of ear involvement and its severity
  • Severity of the adenoid problem
  • Size of the adenoids
  • Allergy tendency [Atopy]
  • Nasal endoscopy findings
  • Presence of tonsillar involvement

Medical treatment is with medications to reduce inflammation and is given for a short period.

Surgical removal [called adenoidectomy] may be recommended if medical treatment fails or the adenoid condition is severe. Not every child requires surgery.Your ENT Specialist will explain to you the choices and factors involved in recommending a particular treatment modality for your child.

What is adenoidectomy?

Adenoidectomy is the surgical removal of the adenoids situated at the back of the throat.

How is adenoidectomy performed?

There are several techniques to do an adenoidectomy.


  • Endoscopic Adenoidectomy – the endoscope and special endoscopic instruments are used to precisely remove the adenoids
  • Adenoidectomy with curettes- curettes are small devices used to literally spoon out the adenoids. Adenoidectomy with curettes is a simple, fast and economic surgical technique.
  • Adenoidectomy with LASER- LASER use produces relatively fast healing.
  • Adenoidectomy with Microdebrider- A microdebrider is a powered instrument which can suck the enlarged adenoid tissue.
  • Endonasal Adenoidectomy- Is adenoidectomy performed through the nose using specialized instruments.

You can discuss the various options with Dr Sonia who will explain to you the benefits of each technique and help you make a decision which is best for your child.

What should I know about adenoidectomy?

  • Adenoidectomy is a fairly simple surgery and one of the commonest surgeries done in children.
  • There is no cutting in the neck or mouth in adenoidectomy. In fact there is no “knife” involved.
  • It is a stitch-less, scar-less surgery.
  • It is performed under General anaesthesia and your child will not have any pain whatsoever during the procedure.

How long should my child stay in the hospital after adenoidectomy?

Depending on the individual case hospital stay varies but in the majority of the cases your child can be taken home the same day or at the most the next day. Discuss with Dr Sonia S V what the recommendation is in your particular case.

What are the precautions after surgery?

Your child will be able to talk, eat and play normally. In fact anyone seeing your child will not know any such procedure has been done as there are no external cuts or stitches involved in this surgery. Dr Sonia usually recommends avoiding very hot food and drinks for a few days after the procedure. He can bathe, play in a normal fashion. In case your child required an adeno-tonsillectomy or a myringotomy grommet along with it additional precautions will be required[Dr Sonia S V will discuss them in detail with you].

What is the success rate for the surgery?

Adenoidectomy has excellent results and tremendous benefits for your child’s health. Timely decision making to avoid the complications of enlarged adenoids is essential to safeguard your child’s breathing , hearing and optimal development.


Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Dr Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




ENT Specialist Bangalore

How to do Nasal irrigation

Posted on July 3, 2010 at 5:37 AM

This is meant for my patients whom I have advised Nasal irrigation

I may have advised a combination of salt and baking soda or salt alone- do so as per the advise I have given you. The video animation is so that you get an idea of the procedure.

You need Adobe Flash Player to view this content.


Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Dr Sonia & Dr Prateek's ENT ,Head & Neck Center ,Sahakaranagar, Bangalore




ENT Specialist Bangalore

How to use Nasal Sprays

Posted on July 3, 2010 at 5:09 AM

How to use Nasal Sprays.

Your doctor may have prescribed a nasl spray for a variety of reasons.

  • Check the expiry date
  • Shake the bottle well
  • Clear your nose before using the spray
  • When using the spray in the right side of the nose you can use the left hand [using the opposite hand gives you the best direction by default]and direct the nasal spray nozzle towards the right ear[ avoid directing it towards the central nasl septum]
  • Breathe out through your mouth .
  • When using the spray in the left side of the nose, use the right hand and direct the nozzle of the spray towards the left ear[avoid directing it towards the central nasal septum].
  • Use the nasl spray while taking in a deep breath[ inspiration].
  • Breathe out through your mouth .
  • Wash your mouth with water after using the sprays.
  • Use only as many puffs as directed by Dr Sonia
  • Use the recommended number of times.
  • Use for the number of days ,weeks or months advised.Some types of sprays take time to act and Dr Sonia may have discussed this with you so complete the recommended duration of treatment so that maximum benefit is obtained.
  • Long term use is harmful so do not self medicate yourself beyond the recommended duration

: Click here for video animation


Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




ENT Specialist Bangalore

Bad Breath - Causes and Cures

Posted on July 3, 2010 at 5:05 AM

Bad Breath- Causes and Cures

By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

The cause of the bad breath [medically called halitosis] may lie in the

  • Mouth
  • Nose and Sinuses
  • Other parts of body

Causes of Bad breath

Cause of Bad Breath in the Mouth

  • Poor oral hygiene
  • Teeth[Dental] origin- decayed teeth,food between teeth
  • Dentures
  • Gum diseases
  • Tongue: coated tongue, fissured/grooved tongue,infection, diseases including cancer of the tongue
  • Poor saliva flow- in night, fasting, not drinking enough water
  • Mouth lining: infection, cancer, diseases
  • Tonsils: Infection, tonsillar stones[ tonsillolith- appear as yellow or white matter in the tonsils- they can be expresed out by pressing the tonsil]

Causes of Bad breath from Nose and Sinuses

Any condition in the nose or sinuses producing post nasal drip [ nasal discharge trickling to the back of the nose and into the mouth] can produce Halitosis[ Bad breath]

Causes of Bad breath other than due to Mouth and Nose

  • Lung infection
  • Bronchial infection
  • Diabetes
  • Kidney Failure
  • Metabloic and biochemical dysfunctions

What is the Cure of Bad breath?

  • First and Foremost get a proper Evaluation to rule out dangerous conditions
  • Improve Oral hygiene
  • Teeth: brushng teeth, dental flossing,using toothpicks
  • Tongue: Brush tongue gently but thoroughyly from back to front and especially brush the back portion
  • Tonsils: Consult your ENT doctor for opinion and treatment of any tonsilloliths[Tonsillar stones] or tonsillar infections
  • Sinuses: Visit an ENT specialist in your locality to check out your nose and sinuses
  • Hydration: Maintain good adequate oral hydration by drinking enough water, not fasting etc
  • Use Chewing gum
  • Medicated mouth washes and gargles- always consult your doctor before regular use as many have high alcohol content and have carcinogenic potential
  • Treatment of the underlying cause


Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




ENT Specialist Bangalore

Allergic rhinitis -Strategies for Prevention and Control

Posted on July 3, 2010 at 4:50 AM


  • Try to be aware of your allergen so that you can take care in future

People with seasonal allergy tend to be affected by pollen. Those who have trouble all year long are generally affected by dust, molds, chemicals, dander, gecko & cockroach droppings etc.

  •  Try to identify
  • when u have the symptoms [time of year, time of day etc]
  • where u have it most[office, home, particular room, outdoors etc]
  • what u were doing when you have it[cleaning house, cooking, driving etc]

The following instructions help prevent and control attacks of allergy:-

  •  If you have seasonal allergy, avoid pollen by
  • using air conditioning during the peak season
  • avoiding outdoor activity during pollen season
  • timing your vacations away from home during this season
  • Masks: Wear a mask when house cleaning or going out into dusty environment
  • Reservoirs of molds -Regular attention should be paid to reservoirs of molds such as refrigerator drip pans, areas around air conditioner condensers & under sinks, indoor plants, and decaying vegetation in the yard.
  • Avoid keeping indoor plants in your home.
  • Remove heavy drapes, stuffed toys and carpets from your home-they are favorite infestation sites for house dust mites.
  • Pets: Avoid keeping dander-producing pets (i.e. cats, dogs, birds etc.) in your home. Otherwise, confine your pet to a particular area of your home, & always keep them out of the bedroom. Bathing your pet frequently is also helpful in decreasing the allergen load.
  • Air conditioning systems: Clean filters often and clean air ducts once a year.
  • Storage: Store rarely used items such as books, old clothes and other knickknacks in plastic covers to avoid dust and mildew.
  • Decrease allergen load in your Living Room

    • Carpets: Carpets and rugs collect dust and are infested by dust mites and their droppings so try to avoid them in your home. If you have to use carpeting, choose low-pile carpets and vacuum once or twice a week. Consider using a high-efficiency particulate air (HEPA) filter vacuum cleaner. Go against the carpet's nap, taking a minimum of six to eight strokes over each area. Empty or replace the bag before it is full. If possible, have someone else do the vacuuming. The allergy sufferer should try to stay out of the area for 30 minutes after vacuuming. If that's not possible, the allergy sufferer should wear a disposable dust mask while vacuuming.
    • Furniture: Dust frequently with a damp cloth.
    • Curtains/Blinds: Launder curtains regularly to remove dust and dust mites. Avoid lacy or long drapes, as they attract dust. Use window shades instead.
    • Rugs: Launder rugs weekly to remove dust and dust mites, animal dander, pollen, and mold. Or shake rugs outdoors regularly.
    • Windows: Keep windows closed during pollen season. Clean window frames and sills regularly for mold or mildew.

    Decrease allergy load in your kitchen

    • Stove: Use an exhaust fan over the stove to remove cooking fumes.
    • Cabinets/Counters: Keep under-sink cabinets and countertops clean and dry. When cleaning, use a disinfectant cleaner designed to kill mildew.
    • Refrigerator: Wipe up excessive moisture in the refrigerator to avoid mold growth. Clean refrigerator walls and shelves regularly with a nonabrasive, all-purpose cleaner or a solution of baking soda and water. Take special care of refrigerator drip pans

    Decrease allergy load from your bathroom

    • Clean bathroom wall tiles, bathtubs and vinyl shower curtains regularly with a bleach or disinfectant cleaner designed to kill mold and mildew.
    • Keep the bathroom door open when not in use.

    Allergy proof your Bedroom

    Since it is often difficult and maybe impractical for you to fully "allergy-proof" your home, at least make sure your bedroom is as allergen-free as possible:


    • Carpet: DO NOT use carpets and rugs in the bedroom.
    • Furniture: move out all unnecessary furniture .Dust frequently with a damp cloth.
    • Curtains/Blinds: Avoid heavy long drapes or lace curtains as they attract dust. Launder curtains regularly to remove dust and dust mites.
    • Collectibles: Get rid of dust collectors such as magazines, knickknacks, and stuffed animals, or store them in closed plastic bags. Avoid keeping books or magazines in the bedroom-they tend to harbor dust mites and molds. A simple rule would be to keep only the book you are currently reading.
    • Cupboards: Keep the cupboard door closed. Store clothing so dust will not settle on it. Keep cupboards cockroach free. Cockroach droppings and decomposing parts are strong allergens.
    • Dressers/Nightstands: Keep dressers and nightstands clear of clutter and dust regularly.
    • Bedding: Check the material from which your pillows are made. Feathers, foam rubber, or pillows more than five years old often have allergens. Use pillows stuffed with Dacron or polyester rather than feathers. Avoid using lace for bed spreads and pillow cases. Substitute woolen blankets for synthetic ones. Launder sheets and pillow cases weekly in hot/warm water and tumble dry. Don't leave wet clothes in the washer. Wash blankets monthly.
    • Mattress/Box springs: To reduce dust and allergens, vacuum both sides of your mattress for at least two minutes twice monthly or use plastic covers for mattress and box springs.
    • Pets: Keep all pets out of the bedroom.
    • Cleaning: DO NOT sweep in your bedroom- use a vacuum cleaner or practice wet mopping

    Build up your general health

    Given below are some tips to build up your general health and immune system so that your body is better equipped to combat the allergen attack successfully

    • Take regular steam inhalation in the colder seasons. Dry, indoor heat aggravates many allergic people. Make sure the humidifier is cleaned regularly
    • Maintain a balanced diet to improve your body's ability to heal itself .Supplement diet with vitamins, especially Vit C.
    • Avoid extremely cold diet/liquids if you notice you are sensitive to it
    • Sleep with a brick or two placed under bedposts at the head of the bed to help relieve nasal congestion and improve sinonasal physiology.
    • Drink adequate fluids (eight 8-ounce glasses per day) to loosen the secretions in your nose and throat
    • Exercise regularly
    • Do not smoke

    The above advice is to be followed only after thorough ENT evaluation as there are many mimickers of allergy.

    If in spite of adequate medication and preventive methods symptoms increase or fresh ones develop, you may have developed a complication of allergic rhinitis.

    Always be aware of the following complications and their symptoms:-

    • Sinusitis: [Long term or severe allergy can affect the sinuses]
    • Any of the following symptoms may develop:-nasal block increasing & not responding to allergy medications, yellowish/greenish nasal discharge, fever, facial pain, headache, halitosis [bad smell from mouth], fatigue, swelling in face.
    • Nasal polyps: [development of mass within the nose-> there may be worsening of symptoms or medicines for allergy are no longer effective].Any of the following symptoms may develop:-nasal block increasing & not responding to allergy medications, expansion of bridge of nose, swelling in face, watering eyes, decreased vision, headache, nasal secretions[sticky or yellowish or green],facial pain, protrusion of eyes. Sometimes nasal polyps may be present without the person knowing and present later with complications such as vision affliction so regular 4- 6 monthly checkups are essential in all allergic rhinitis sufferers.
    • Eustachian tube dysfunction & otitis media: [affects functioning of the ear due to affliction of tube connecting the back of the nose to the ear] .Any of the following symptoms may develop:-pain or discomfort in the ears, ringing in ears, dizziness, fullness or blocked sensation in ears, and decreased hearing.

    Dr Sonia Suprabha Venugopal


    Consultant ENT & Head & Neck Surgery

    Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




    ENT Specialist Bangalore

    Allegic Rhinitis

    Posted on July 3, 2010 at 3:47 AM

    By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

    Allergic rhinitis is a common condition causing considerable distress to the sufferer.Allergic rhinitis is the commonest allergy encountered in clinical pratice and constitutes more than 50% of all allergies seen in india. In fact, 1 in 6 people suffer from allergic rhinitis, which makes it the commonest chronic disease of man today and even now it’s incidence is steadily increasing.

    Allergic rhinitis is characterised by

    • Sneezing
    • Nasal Discharge/ Secretions- classically watery
    • Itching - nose, eyes, throat,roof of mouth[ palate]
    • Nasal Block

    What are the complications of Allergic rhinitis ?

    Longstanding allergic rhinitis produces mucociliary abnormalities in the lining of the nose and respiratory passages producing complications in the nose, adjacent sinuses , ear ,throat and lower air passages.This commonly manifests in the form of

    • Sinusitis [producing facial pain, headache, nasal secretions, nasal block]
    • Nasal polyposis[development of mass within the nose-> patient may perceive worsening of symptoms or that medicines for allergy are no longer effective]
    • Ear Affliction:Eustachian tube dysfunction, otitis media [affects functioning of the ear due to affliction of tube connecting the back of the nose to the ear. This can produce ear fullness, ear pain, hearing loss, dizziness,tinnitus]
    • Lower respiratory tract infections
    • Asthma -Asthma and allergic rhinitis frequently co-exist, with allergic rhinitisprecedeeing deveopment of asthma in about 45 % of patients. It is now well documented in medical literature that adequate nasal treatment can improve pulmonary functions. Patients with nasal allergy often have a hypersensitive airway ie they are at risk or may in fact be having bronchial asthma.Early diagnosis, adequate treatment of allergic rhinits is an important preventive measure for development of asthma

    Due to the high incidence of allergic rhinitis in our country and locality we should be aware of the complications of this common condition.

    How is Allergic rhinitis Diagnosed?

    Assessment of person with allergic symptoms will include a detailed history and physical examination by the ENT Specialist. Certain conditions closely mimic allergic rhinitis [e.g. vasomotor rhinitis, allergic fungal sinusitis] and it is very important to clinch the diagnosis.Often the patient would have been taking various over the counter anti-allergy medicines for long periods when actually he is suffering from some other condition altogether! Hematological investigations and radiological assesment may be required based on the individual patient.

    What are the precautions if you have Allergic rhinitis ?

    • Be aware of your allergens
    • Be aware of the complications of Allergic rhinitis
    • Get a periodic check up by your ENT specialist-Patients with allergic rhinitis should periodically be assessed with real time endoscopes for detailed evaluation of their sinonasal status for early detection of complications and sequelae.
    • Allergy proof your home - see next article

    Dr Sonia Suprabha Venugopal


    Consultant ENT & Head & Neck Surgery

    Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




    ENT Specialist Bangalore

    Head and Neck Cancer

    Posted on June 30, 2010 at 5:39 AM

    By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

    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 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]


    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


    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]


    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,voice box

    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 abd cinsult an ENT Specialist with expertise in management of Head and Neck cancers


    Dr Sonia Suprabha Venugopal


    Consultant ENT & Head & Neck Surgery

    Sonia & Prateek's ENT,Head and Neck Center,Sahakaranagar, Bangalore




    ENT Specialist Bangalore

    Air travel -Health tips

    Posted on June 26, 2010 at 5:22 PM

    Air travel has its specific set of health problems and we may have heard of some of them.

    The important health issues are:-

    • Ear  problems
    • Jet Lag
    • Deep Vein Thrombosis[DVT]
    • Motion Sickness

    Jet lag

    Jet lag is caused when you travel through multiple time zones. These changes in time zones confuse your body's inner clock and produce biochemical cahnges Inferior turbinate the body. Symptoms of Jet lag include fatigue, insomnia, disorientation, headaches Overeating, smoking and drinking alcohol can  worsen jet lag.

    Tips for dealing with Jet Lag:

    • Do some gentle mild exercise while airborne and upon arrival .

    • Adjust your sleep time before you leave on your trip to match your destination time zone.

    • Don't stay on your home time zone. Change your watch to your destination time zone and try to adjust to the new time zones as early as you can

    • Drink enough water.

    Ear Pain

    The ear is made of 3 parts- outer ear, middle ear and inner ear.During  flights the ears are subjected to changes in air pressure. The middle ear is connected with the back of the nose by the eustachian tube which equalizes air pressure in the middle ear to that in the encironment.

    People often have more problems during landing. If the Eustachian tube is not functioning properly due to a cold or allergy the eardrum will be retracted inward due to the negative pressure building in the middle ear, producing ear blockage,impaired hearing and evn ear pain during descent.

    Tips for dealing with Ear Pain:

    • Try yawning wide 
    • Try swallowing slowly and do this repeatedly
    • Try chewing gum or suck on a piece of candy
    • Try the Valsalva maneuver: Hold your nose with both your fingers,close your mouth and blow out gently against it to pop the ears.This valsalva manoeuvre can help push air through the eustachuan tube in to the middle ear  to equalize the pressure. This should not be done if you are suffering from a cold or sinus infection.


    • Avoid flying if you have a cold
    • DO Not fly if you have a middle ear infection
    • If you frequently get ear discomfort  or suffer from a sinonasal condition meet your ENT specailist who will examine your nose and ears to diagnose any predisposing condition and prescribe a decongestant nasal drops and advise you on the correct dosing and schedule prior to your flight.
    • You might try earplugs and cotton in the ear canal during the flight .
    • Do not sleep during take off and landing
    • Do not smoke
    • Do not drink alcohol inflight or prior to flying
    • Babies and Children:Feed your baby during take off and landing.Give an older child candy to suck on during take off and landing.

    What makes you prone for ear problems while flying?

    • Children-Young children have immature eustachain tubes and are especially prone for ear pain and other ear problems while flying. Feed your baby during take off and landing.Give an older child candy to suck on during take off and landing.Discourage sleeping during take off and landing.
    • Ear drum architectural abnormalities- eg thin or retracted ear drums
    • Sufferers of disease in nose and sinuses, Allergic rhinitis

    Deep Vein Thrombosis (DVT)

    Deep Vein Thrombosis (DVT) can sometimes occur during long flights due to inactivity. Blood flow slows down, especially in the lower legs, and clots can form. Sometimes there are no symptoms until several days after the flight when DVT can be mistaken for a cramp in the legs. It is a serious medical condition requiring emergency treatment. Overweight individuals are at risk for DVT.

    Tips for preventing DVT:

    • Flex your legs frequently (at least every 30 minutes) while seated.

    • Try compression stockings

    • Avoid sitting with your legs crossed for more than a few minutes.

    • Drink  enough water.

    • Avoid dehydrating beverages such as alcohol & caffeine.

    • If you have DVT  risk factors discuss your flight travel plans with your doctor and you may be given a prescription  of DVT preventing medicines

    Motion Sickness

    Motion sickness can occur in turbulence, while turning or even in routine flights.At such times inner ear fluid mechanisms can be affected and produce the unpleasant symptoms of dizziness, nausea, increased salivation, sweating and even vomiting

    Tips for dealing with Motion Sickness:

    • Try sitting near the plane's wings. This will reduce the motion felt.

    • Try over the counter medications or visit an ENT specialist for a prescription before flying

    • Try Ginger (capsule form) and peppermint (mint-flavored candies).

    • Eat lightly before and during your flight.

    • Sit at a window seat.

    • Don't read.

    • Open your air vent.

    Other  Travel Health Advice

    • Try not to fly within twelve hours after dental work because the change in cabin pressure can be painful.

    • Avoid drinking  alcohol.

    • Carry your health prescriptions and short medical history including allergies. Keep important medications in your hand baggage[ make sure you have your doctor;s prescription orders for these for security reasons]

    Dr Sonia Suprabha Venugopal


    Consultant ENT & Head & Neck Surgery

    Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore



    ENT Specialist Bangalore

    Article in Deccan Herald -on Sinusitis

    Posted on June 25, 2010 at 11:48 PM

    See article which appeared in Deccan Herald authored By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore : Click here


    Posted on June 23, 2010 at 5:38 AM

    By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

    What is a Tonsillectomy?

    Tonsillectomy is a procedure done to remove the tonsils situated on the side of your throat.

    Though there are many reasons your doctor may advise you to remove the tonsils ,the international guidelines  in majority situations are:-

    Absolute indications[Compulsory removal]

    ◦Enlarged tonsils that cause upper airway obstruction, severe swallowing problem[dysphagia], sleep disorders[sleep apnoea], or cardiopulmonary complications[heart -lung problems]

    ◦Peritonsillar abscess -If a child or adult has had a peritonsillar abscess in the past the recommendation is to remove the tonsils after recovery as there is chance for such severe infections again in the future .

    ◦Tonsillitis resulting in febrile convulsions[ fits/ seizures]

    ◦Tonsils requiring biopsy to define tissue pathology  as in doubt of cancer or other diseases.

    Other indications

    ◦3 or more tonsil infections per year despite adequate medical therapy

    ◦Persistent foul taste or breath [halitosis]due to chronic tonsillitis that is not responsive to medical therapy

    ◦Chronic or recurrent tonsillitis

    ◦Unilateral tonsil hypertrophy that is presumed to be neoplastic[cancer]. One sided tonsillar enlargement is especially notorious for harboring diseases such as cancer hence if your doctor finds a one sided enlargement or a suspicious looking tonsil he/ she may recommend removal of the tonsil and histopathological examination [ examination under the microscope]

    Is it inadvisable to remove the tonsils?

    The tonsils are a vestigeal structure in our body and no harm comes from removal of the tonsils .On the other hand keeping a diseased tonsil with clear cut indications for removal will do more harm to the body.

    In certain situations the removal of the tonsils are not recommended.Such situations are:-

    Bleeding disorders such as haemophilia

    Anaemia[low Hemoglobin]

    Poor Anaesthesia Risk

    During the episode of Acute infection [Ongoing infection with severe pain and fever] 

     How is tonsillectomy done?

    Tonsillectomy is safest done under  general anaesthesia[the patient will be sleeping during the procedure].Various techniques may be used to prform a tonsillectomy and you may discuss the modality best suited for you with Dr Sonia.

    Techinques of Tonsillectomy

    Tonsillectomy can be done by various methods

    Cold Knife


    Dissection method

    How long does the procedure take?

    Though the actual removal of the tonsils takes only some minutes the whole process including the anaesthesia may take about half an hour to one hour.

    When can I / my child go home?

    In selected cases tonsillectomy can be done as a daycare procedure, that is you can go home the same day. In other cases you may go home next day morning.

    What are the complications of tonsillectomy?

    The main complication of tonsillectomy is bleeding and that is why in certain cases  doctor may advise you to stay overnight to be on the safe side.

    Will I have pain after the procedure?

    Some amount of pain will occur after the procedure and Dr Sonia will give you pain killers to take care of it.

    What  are the precautions after tonsillectomy?

    • You will be prescribed antibiotics and pain killers after the tonsillectomy.Take the medicines prescribed by Dr Sonia on time.
    • Pain killers are generally best taken after food so as to avoid gastric irritation.
    • Try to gargle with salt water or the medication prescribed as frequently as possible as this helps tremendously in early healing and pain relief.
    • Special medicated analgesic[pain relieving] gargles will be prescribed by Dr Sonia depending on the individaul case- If there is pain on eating ,you may  gargle with these medicines 10 minutes before eating so as to enable you to eat and drink well.
    • Drink enough water and have adequate food - both these allow early healing and optimal recovery.
    • Maintain a good oral hygiene by brushing the teeth twice a day.
    • Be careful while eating fish with thorns.
    • Avoid hard chips such as banana and tapioca chips for  10 days after the tonsillectomy

    Dr Sonia Suprabha Venugopal


    Consultant ENT & Head & Neck Surgery

    Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




    ENT Specialist Bangalore


    Tonsillitis- Do you have tonsillitis?

    Posted on June 23, 2010 at 5:33 AM

    Tonsillitis- Do you have tonsillitis?

    By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore


    Tonsillitis is inflammation of the pharyngeal tonsils[at the sides of the throat]. The inflammation may extends to the adenoids [lymphoid tissue at the back of the nose]and the lingual tonsils[lymphoid tissue at the back of the tongue and is then referred to as pharyngitis.

    It can affect adults and children

    Infection may be bacterial or viral

    Types of tonsillitis

    Acute [present now]

    Chronic[ long standing]


    What are the symptoms of tonsillitis?

    In Acute tonsillitis common symptoms are:-


    Sore throat

    Foul breath

    Swallowing difficulty

    Painful Swallowing

    Lumps in Neck- which are tender

    Ear Pain

    Airway obstruction may manifest as mouth breathing, snoring, night time breathing pauses

    Tiredness, Fatigue,Weakness

    If complicated by Peritonsillar abscess in addition to the above complaints the person can have

    Drooling of saliva[ saliva flows out of mouth]

    Difficulty opening the mouth[Trismus]

    Voice alteration("hot potato" voice)


    Dr Sonia Suprabha Venugopal


    Consultant ENT & Head & Neck Surgery

    Sonia & Prateek's ENT Speciality Center,Sahakaranagar, Bangalore




    ENT Specialist Bangalore