A Simple Guide to Meniere's Disease

A Simple Guide to Meniere's Disease
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What is Meniere's Disease?
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Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.

It is more common in adults between 30-60years of age and in men more than women.

It usually occurs more in one ear.

What are the causes of Meniere's Disease?
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The exact cause of Meniere's Disease is unknown.

It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.

As a result the balance in one ear is affected leading to dizzines

The possible triggers of this condition may be:

1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt

Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).

What are the symptoms and signs of Meniere's Disease?
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Symptoms:
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The classical triad of symptoms are:

1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.

2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.

3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears

Beides these symptoms, there is also :

4.feeling of pressure9fullness) in one or both ears.

5.Nausea and vomiting sometimes occur with the vertigo

6.hypersensitivity to sound

7.nystagmus(uncotrollable jerky eye movements)

8.cognitive performance

How is the diagnosis of Meniere's Disease established?
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1.classical history

2.audiometry shows impairment of hearing

3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)

What is the Treatment of Meniere's Disease?
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Initial treatment:

1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate


Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate

2. mild diuretic

3.vitamin B6

4.antihistamines,

5.anticholinergics,

6.corticosteroids orally or injection of steroid medication behind the eardrum

7.Bed rest

8.stress reduction.

9.low-sodium diet.

10.avoid caffeine, alcohol and cigarettes



Surgery :
is only required if the above treatment does not control the vertigo

1.Decompression of the endolymphatic sac may help to relieve symptoms.

2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.

a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.

b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically

c.surgical removal of the inner ear (labyrinthectomy).

Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.

3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.

What is the prognosis of Meniere's Disease?
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Symptoms may remain the same, worsen or disappear spontaneously.

1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.

2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.

3.Tinnitus usually is more pronounced with time.

A Simple Guide to Hydrocoele

A Simple Guide to Hydrocoele
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What is Hydrocoele?
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Hydrocoele is the excess accumulation of fluid inside the sac containing your testis.

What causes Hydrocoele?
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The causes of Hydrocoele are mostly due:

A.Congenital:
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Children are born with with enlarged testicular sac with fluid which communicate with abdominal cavity through a patent duct which should be closed at birth.

B.Infections:
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Infections of the testicle can cause inflammation of the cavity surrounding the testicle and its appendages.

c. Obstruction to fluid flow:

Obstruction to lymphatic and venous flow in the testicular cavity prevents the fluid in the testicular cavity from being re-absorbed into the general system.

What are the symptoms of Hydrocoele?
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The Symptoms of Hydrocoele are:

1.heaviness anf fullness of the scrotum

2.enlargement of scrotum usually on 1 side

3.usually painless except when inflammed or infected

Signs:

1.redness and swelling of the scrotum

2.enlargement of the scrotum on 1 side

5.Inguinal lymph nodes may be swollen and painful if there is severe infection(rare)

What are the complications of Hydrocoele?
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1.Abscess formation

2.torsion of the testicle(rare)

How is diagnosis of Hydrocoele confirmed?
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1. clinical features and trans-illumination of scrotal swelling

3. Ultrasound scan of the scrotal swelling to exclude any tumors of the testicle or torsion.

What is the treatment of Hydrocoele?
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1. Aspiration of the fluid in the scrotal cavity usually helps to reduce swelling but recurrences are common

2.Rest and support of the scrotum with loose underwear

3. surgery with drainage of fluid from scrotum.

The scrotal cavity is opened up and the fluid drained.

If the testicle is normal it should be left alone.

If the testicle is disease and shrunken, it is usually removed.

What is the Prognosis of Hydrocoele?
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Most cases of Hydrocoele usually will recover with surgical treatment.

Aspiration is a temporary measure as recurrences are common.

Congenital cases of Hydrocoele usually resolve spontaneously

What are the Preventive measures for Hydrocoele?
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Avoid too tight underwear which can obstruct the lymphatic or blood vessels of the scrotum.





















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A Simple Guide to Inguinal Hernia

A Simple Guide to Inguinal Hernia
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What is Inguinal Hernia?
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Inguinal Hernia is protrusion of the part of the viscera(contents in the abdominal cavity) through the inguinal canal which is the tunnel which leads the spermatic duct from the testis to the urethra or seminal vesicles in the abdomen.

What are the different types of Inguinal Hernia?
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1.Indirect:

The abdominal contents such as small intestine enter the the enlarged internal inguinal ring and protrude into the inguinal canal entering the scrotum.

2:Direct:

The abdominal contents find a weak spot in the abdominal wall and enter the the inguinal canal.

What causes Inguinal Hernia?
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The causes of Inguinal Hernia are mostly due:

A.Congenital :
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The inguinal canal follows the same route as the descent of the testes from the abdomen out to the scrotum outside the abdomen during the embryonic stage.

If there is partial closure of the internal inguinal ring, then weakness of the of abdominal wall occurs allowing abdominal content to protrude through the inguinal canal.

B.Increased abdominal pressure:
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Increased intra-abdominal pressure can occur as a result of :

1.coughing

2.straining

3.distension

4.obstruction

C.Weakening of the abdominal muscle:
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1.Obesity

2.muscle wasting diseases

Hernias are more common in men than in women because the inguinal canal is usually closed in women whereas in men the canal carries the spermatic duct.

What are the symptoms of Inguinal Hernia?
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Symptoms:

1.Swelling in the groin area which is worse on coughing, straining or standing up

2.swelling of the groin usually disappear on lying down(abdominal contents is returned to the abdominal cavity).

3.Pain or discomfort may be present

Signs:

1.Swelling in the groin can be felt.
If a finger is pressed into the external inguinal ring, coughing can make the swelling feel more palpable

2.There may gurgling sounds of intestinal gas movement on auscultation of the swelling with the stethoscope.

3.Local tenderness of swelling

What are the complications of Inguinal Hernia?
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1.Irreducible hernia may occur when the abdominal contents cannot be returned to the peritoneal cavity due to adhesions of the inguinal canal of the faecal matter stuck in the protruded intestine.

This complication may be serious

2.Strangulated hernia occur when the blood circulation is cut off due to constriction of the neck of the hernial sac resulting in ischemia and gangrene of the gut.

Signs and symptoms of intestinal obstruction then becomes obvious with increased abdominal pain and local tenderness.

This is a medical emergency and should be treated immediately.

3.Peritonitis - burst abdomen as a result of intestinal obstruction

How is diagnosis of Hernia confirmed?
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1. clinical features of swelling in the inguinal area

2. CT and Ultrasound scan of the inguinal region and scrotum to exclude hydrocoele and tumors

What is the treatment of Hernia?
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1. At the early stage of inguinal hernia, a truss which press against the internal inguinal ring may help to elevate symptoms and prevent the hernia from bulging out.

They are useful in patients with poor general condition who are unable to tolerate full surgery.

They are seldom used now.

2.All inguinal hernia patients should undergo elective (non-emergency) surgery to repair the hernia before complications such as strangulated hernia sets in.

Such surgery called herniorrhaphy or hernioplasty can be done on a day surgery under local anethesia and using laparoscopy.

It usually involved sewing a wire mesh over the inguinal ring to tighten the inguinal ring and prevent the contents of the abdomen from pushing its way out into the inguinal canal.

Patient is usually asked to cough after the surgery to make sure the abdominal wall is tight enough to prevent any intestine to protrude out.

3.Emergency surgery is required if there is any strangulated inguinal hernia or intestinal obstruction.

4.Most congenital hernia may disappear by the end of the first year.


What is the Prognosis of Hernia?
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Most cases of inguinal hernia usually will recover with proper surgical treatment.

Very rarely there may be complications such as postoperative infections or recurrence.

What are the Preventive measures for Hernia?
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Avoid straining at stools, severe coughing.

Avoid carrying heavy weights.

Lose some weight.

A Simple Guide to Pneumothorax

A Simple Guide to Pneumothorax
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What is Pneumothorax?
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Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.

What are the types of pneumothorax?
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Tension pneumothorax:
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This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.

Non-tension pneumothorax:
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A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.

Hemopneumothorax:
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When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.

What is the causes of pneumothorax?
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It is most commonly due to:

Spontaneous pneumothorax
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This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:

1.tall young males and in Marfan syndrome

2.Tuberculosis

3.Bronchial obstruction

4.Cancer

Non-spontaneous pneumothorax
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1.penetrating chest wound

2.surgical trauma

3.pleural effusion tap

What are the Signs and symptoms of Pneumothorax?
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Symptoms:
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1.Sudden onset of chest pain, back

2.shortness of breath,

3.dry coughs,

4.cyanosis (turning blue)

5.coma

Signs:
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1.Pale or cyanotic

2.Percussion show resonance at normal lung while none at the pneumothorax lung area

3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung

4.There may be a characteristic clicking sound with respiration.

5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .

6.The flopping sound of the punctured lung can sometimes be heard

How is the Diagnosis of Pneumothorax made?
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Physical examination:
a. absence of audible breath sounds through a stethoscope

b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.

c.Two coins when tapped on the affected side results in a tinkling resonant sound

Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.

Medistinal shifts can be seen on inspiratory and expiratory films

CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.

What is the complication of Pneumothorax?
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Respiratory failure with circulatory collapse

What is the treatment of Pneumothorax?
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All pneumothorax patients are to be admitted to hospital for treatment.

1. Small spontaneous pneumothorax
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A small spontaneous pneumothorax can be left alone to reabsorb on its own.

The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.

2.Tension Pneumothorax
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Tension Pneumothorax is a medical emergency.

Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.

Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.

The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.

The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays

Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.


Penetrating wounds:
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A chest drain is inserted first before any treatment of the wounds is done.

Supprtive treatment:
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Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain


Recurrent pneumothorax
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1.pleurodesis may be required in recurrent pneumothorax.

2.bullectomy (the removal or stapling of bullae).

3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.

4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues

5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery

What is the prognosis of Pneumothorax?
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It is usually good following treatment.

However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.

A Simple Guide to Infectious Mononucleosis

A Simple Guide to Infectious Mononucleosis
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What is Infectious Mononucleosis?
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Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.

What is the cause of Infectious Mononucleosis?
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The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.

It is more common in young adults.

The incubation period (from contact to illness) is 10-15 days.

It is usually sporadic but may be epidemic.


What are Signs and symptoms of Infectious Mononucleosis?
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The triad of symptoms which are common to Infectious Mononucleosis are:

1.Neck and axillary lymph nodes are enlarged

2.Fever with headache

3.sore throat with sometimes extensive tonsillar exudates and swelling

Other symptoms are:

4.fatigue

5.bodyaches

6.jaundice(rare)

Signs:

1.Throat is red and inflamed with enlarged tonsils

2.Pinpoint petechiae at junction of hard and soft palate

3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region

4.Swelling of lacrimal glands and eyelids

5.Spleen is enlarged in 50% of cases

6.Generalized maculopapular rash may occur

Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.

Disease usually lasts for 2-3 weeks.

How is the diagnosis of Infectious Mononucleosis made?
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1.Classical symptoms and signs as above especially lymph nodes enlargement.

2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.

3.Blood for Epstein Barr antibody

3.X-rays of chest and abdomen

4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.

What are the complications of Infectious Mononucleosis?
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1.Obstruction to airway from enlarged lymph nodes

2.thrombopenic purpura

3.myocarditis

4.pericarditis

5.lymphocytic meningitis

6.encephalitis

7.polyneuritis

8.hepatitis

What is the treatment of Infectious Mononucleosis?
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1.Bed rest in isolation ward

2.Adequate fluids

3.Antipyretic medicines such as paracetamol for fever

3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis

4.High-flow oxygen and tracheostomy in airway obstruction

What is the prognosis of Infectious Mononucleosis?
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Prognosis of Infectious Mononucleosis is generally good.

Epstein Barr infections has been associated with nasopharyngeal cancer.

What are the Preventive measures taken for Infectious Mononucleosis?
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Isolation of cases at home or in hospital.

Avoid contacts.