What is Benign Paroxysmal Positional Vertigo (BPPV) | ENT Specialist

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder that causes the most common cause of vertigo, very specific dizziness, in which you feel the room spinning around you. Each part of the name describes an important part of the situation:

  • Benign means that it is not very serious. Your life is not in danger.
  • Paroxysmal means that you suddenly touch yourself, stay for a while and come and go.
  • Position means that you induce vertigo with certain postures or movements of the head.
  • BPPV is common and can usually be treated in a doctor’s office.

In rare cases, the problem can be serious if it is more likely to fall. If you take these attacks frequently, they may indicate other medical conditions. But they are often difficult to diagnose. If you have BPPV, you may have mild or severe dizziness. Changing the position of your head triggers the episode. Other actions that trigger a BPPV episode:

  • Turning the head up or down
  • Lying down
  • Turning
  • lifting up

BPPV can be uncomfortable, but dizziness is rarely serious, except when someone falls.

What happens at BPPV?

In most people, especially the elderly, there is no specific appearance of BPPV, but there are some factors that can provoke an attack:

  • Mild to severe head injury
  • Extended headrest in the dentist chair, salon, or sturdy bed rest
  • Riding a bike on rough trails
  • High-intensity aerobics
  • Another inner ear disease (ischemic, inflammatory, infectious)

Symptoms of BPPV

You can bend or change the position of your head at any time. You can lose your balance and fall. You may fear that something has gone wrong. Symptoms of BPPV include:

  • Vertigo
  • Vomiting
  • Blurry vision
  • Nausea
  • Dizziness
  • Mild headache
  • Loss of balance
  • Instability

The most common symptoms can include:

  • The feeling of the room spinning
  • Nausea
  • Vomiting
  • Instability
  • Mild headache

When to call your doctor. If you have dizziness for more than a week, you should make an appointment with your doctor. You will be able to detect an ear infection before your visit. Here’s how to do it:

  • Sit on your bed so that your head hangs over the edge when you lie down
  • Turn your head to the right and lie down quickly
  • Wait 1 minute. If you feel dizzy, the right side is affected
  • If you don’t feel dizzy, sit down, wait a moment, and repeat the test on your left side
  • If you feel dizzy when you repeat the test, your left side will be affected

Call your doctor right away if you feel dizzy or:

  • New or severe headaches can occur
  • You have a fever
  • Are you looking double or not?
  • Difficult to speak
  • You are falling or you cannot walk

Symptoms of BPPV can come and go. They usually last less than a minute.

Causes of BPPV

BPPV is the result of altering the inside of your inner ear. The semicircular canals or tubes in the ears contain fluid that moves when the body position changes. Semicircular drains are very delicate. BPPV develops when small crystals of calcium carbonate, which are normally found in another area of ​​the ear, break open and enter the semicircular canals. This also happens when these crystals form within semicircular canals. This is when your brain receives confusing messages about the position of your body.

Sometimes the crystals break off from the normal area of ​​your ear and go to other areas, including your ear canals. Once there, they can play together. Since clay is heavy compared to other objects in your ear, it will sink to the lowest part of your inner ear. When you change or change position, it causes the fluid in the inner ear to rotate after it stops moving. Create the impression that you are still moving. There are several ways to trigger BPPV by moving your head in a certain way:

  • Rolling in bed
  • Get in and out of bed
  • Yoga leans for posture
  • Tilt your head back in the salon to wash your hair
  • Rapid head movements

In general, you can expect to have rhythmic eye movements when it comes to BPPV. Your doctor will call it “nystagmus” and they will look for you if they think you have vertigo.

Risk factors of BPPV

BPPV occurs suddenly, for no apparent reason. You will most likely get it if you grow up. Parts of the inner ear begin to show wear. It is more available to women than men. In people younger than 50 years old, head injury is the most common cause of BPPV. It can be as small as a sneeze or blow to the head or as serious as a concussion or a vehicle crash.

Other reasons:

For example, having the head in the same position, at the dentist’s office or the hairdresser.

  • High-intensity aerobics
  • Riding a bike on rough trails
  • Inner ear disorder such as Meniere’s disease
  • Prolonged stay in the hospital or on bed rest
  • A specific type of migraine.

Diagnosis of BPPV

Your doctor can diagnose BPPV by performing a maneuver called the Dix-Hallpike test. Your doctor will position your head in a certain position while asking you to quickly lie on your back on the table. During this test, they will look for unusual eye movements and may ask if you are experiencing a spinning sensation. Your doctor will also do a routine physical exam. They obtain a complete medical history and undergo a neurological exam to rule out other disorders or diseases.

Additional tests may include:

  • Caloric stimulus, which heats and cools the inner ear with water or air to observe eye movements
  • Magnetic resonance of the head
  • Magnetic resonance angiography (MRA) of the head, similar to MRI
  • Computed tomography (CT scan)of the head
  • Hearing evaluation

Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movements. ENG (using electrodes) or VNG (using small chambers) can help determine if dizziness is caused by inner ear disease by measuring involuntary eye movements when the head is placed in different positions or when the extremities are stimulated. balanced with water or air.

Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to diagnose and diagnose many conditions. An MRI may be done to rule out other causes of vertigo.

Treatment for BPPV

This condition is episodic and often goes away on its own. Your doctor can stop your BPPV with in-office treatment that will move loose crystals in your ear to a less problem area. To do this, many people can use these methods:

  • Apple maneuver: A physical therapist or audiologist can do the trick too, or you can do it yourself at home.
  • Semont maneuver: This is the USA less common than Apple in. Each one takes about 15 minutes.
  • Establishment of channel repositioning: You hold all four positions for about 30 seconds or until the symptoms disappear.

You should rest in the office for 10 minutes before going home to ensure that you do not have rapid bouts of vertigo as the crystals regenerate. You need someone to drive you. Wear comfortable clothing so that you can move easily.

Surgery: It happens less and less often, but very rarely, you may need surgery to cure your BPPV. Your surgeon will plug a part of your inner ear to prevent small calcium crystals from moving in your ear canal. Surgery has a small chance of complications, including hearing loss.

Drugs: Your doctor may prescribe medication to eliminate the spinning sensations. These may include:

  • Palliative hypnotics or sleep aids
  • Anticholinergics, which work by blocking the neurotransmitter acetylcholine.
  • Antihistamines

However, medications are often ineffective in treating vertigo.

Cure with home remedies: There are steps you can take to manage the dizziness associated with BPPV. Be aware of your surroundings and avoid putting yourself in danger. Losing your balance is always an opportunity. The waterfall can cause serious injury.

Take a seat when you feel dizzy. Sitting during a dizzy spell can help prevent you from falling. You need to be careful to have good lighting around your house and use a cane for stability.

If you experience dizziness associated with BPPV, consider these tips:

  • Be aware of the possibility of losing your balance, which can lead to falls and serious injury
  • Avoid movements that bring symptoms
  • Sit up immediately when you feel dizzy
  • Use good lighting if you get up at night
  • Walk on a cane for stability if you are at risk of falling
  • Work with your doctor to effectively manage your symptoms

BPPV can come back even after successful treatment. Although there is no cure, the condition can be controlled with physical therapy and home remedies.


Overview of the Nasopharynx In Children | ENT Specialist

What is nasopharynx in children?

Nasopharynx in children, nasopharyngeal cancer is the formation of malignant (cancer) cells in the tissues of the nasal cavity and throat. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the nasopharynx. The nasopharynx is made up of the nasal cavity (inside the nose) and the upper part of the throat.

The nasopharynx is more common in adolescents than in children under 10 years of age. Epstein-Barr virus infection increases the risk of the nasopharynx. Any risk factor that increases the chance of getting a disease is called. Having a risk factor does not mean you have cancer; The lack of risk factors does not mean that you will not have cancer. Talk to your pediatrician if you think your baby is at risk.

Symptoms of the nasopharynx

Nasopharynx signs and symptoms; headache and a stuffy or runny nose. These and other signs and symptoms can be caused by nasopharynx or other conditions. Check with your pediatrician if your child has any of the following:

  • Headache
  • The nose is stuffy or swollen
  • Nosebleeds
  • Deafness
  • Ear infection
  • Hearing loss
  • Problems moving the jaw
  • Trouble speaking
  • Looking at the eyelid or looking at the drooping
  • Lumps in the neck can be painful

Diagnosis of nasopharynx

Tests that examine the nasopharynx can help diagnose nasopharyngeal cancer. The following tests and procedures can be used:

  • Physical exam and health history: An exam of the body to detect general signs of health, including the appearance of lumps or any abnormalities. The health habits of the patient and the history of previous diseases and treatments are also taken into account.
  • MRI (magnetic resonance imaging): The process of using magnets, radio waves, and a computer to create a series of detailed images of parts of the body such as the head and neck. This procedure is also known as nuclear magnetic resonance (NMR).
  • Nasal endoscopy: A procedure that examines organs and tissues inside the body to examine abnormal areas. A flexible or fixed endoscope is inserted through the nose. The endoscope is a thin tube-shaped device that is lightweight with a lens for viewing. It may have a tool to remove tissue samples, which a pathologist examines under a microscope for signs of disease.
  • Epstein-Barr virus (EBV) testing: A blood test to detect antibodies to the Epstein-Barr virus and Epstein-Barr virus DNA markers. They are found in the blood of EBV patients.

Stages of nasopharynx

After the nasopharynx is diagnosed, tests are done to see if cancer cells have spread to the nasal cavity and throat or other parts of the body. To plan treatment, it is important to know if cancer cells have spread to the nasal cavity or other parts of the body. The process used to find out if cancer has spread is called staging. Most children with nasopharynx are in an advanced stage at the time of diagnosis. nasopharynx most often spreads to the bones, lungs, and liver.

The following tests and procedures can be used to find out if cancer has spread:

  • Neurological exam: A series of questions and tests to check the function of the brain, spinal cord, and nerves. The test examines a person’s mood, coordination, and ability to walk normally and how well muscles, senses, and reflexes work. This is also known as a neurological test or neurological test.
  • Chest X-ray: An X-ray of the organs and bones inside the chest. X-rays are a type of energy beam that can pass through the body and into the film, creating an image of areas inside the body.
  • PET-CT scan: The process of combining images from a PET scan and a CT scan. PET and CT scans are performed simultaneously on the same machine. Combine images from both scans to create a more detailed image than the actual test produces.
  • Computed tomography (CT) scan: The process of creating a series of detailed images taken from different angles, such as the chest or abdomen within the body. The pictures are created by a computer linked to an x-ray machine. A dye may be injected into a vein or to help organs or tissues become more visible. This procedure is also known as a CT scan.
  • Bone scan: A procedure to check for the presence of rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected intravenously and travels through the bloodstream. The radioactive material collects in cancerous bone and is detected by a scanner. The drawing shows a child sliding under a scanner, a technician operating the scanner, and a computer monitor displaying images taken during the scan. A small amount of radioactive material is injected into a child’s vein and travels through the blood. Radioactive material accumulates in the bones. When the child lies on a slippery table under the scanner, the radioactive material is detected and images are created on the computer screen.

There are three ways that cancer can spread throughout the body.

Cancer spreads through tissues, the lymphatic system, and the blood:

  • Tissue: Cancer spreads from where it started growing to nearby areas.
  • Lymphatic system: It spreads from the cancer site to the lymphatic system. Cancer travels through lymphatic vessels to other parts of the body.
  • Blood: Cancer spreads from where it started by entering the bloodstream. Cancer travels through blood vessels to other parts of the body.

The cancer started in other parts of the body:

  • When cancer spreads to another part of the body, it is called metastasis. Cancer cells divide from where they started (the primary tumor) and travel through the lymphatic system or blood.
  • Lymphatic system. Cancer enters the lymphatic system, travels through the lymphatic vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. Cancer enters the bloodstream, travels through blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • A metastatic tumor is a cancer of the same type as a primary tumor. For example, if nasopharyngeal cancer has spread to the lungs, the cancer cells in the lungs are actually nasopharyngeal cancer cells. The disease is metastatic nasopharyngeal cancer, not lung cancer.

Treatment for nasopharynx

There are a variety of treatments for children with the nasopharynx. Some treatments are standard (treatment currently in use), while others are being tested in clinical trials. Treatment A clinical trial is a research study that can help improve current treatments or obtain information about new treatments for patients with cancer.

When clinical trials show that the new treatment is better than the standard treatment, the new treatment may become the standard treatment. Since cancer is very rare in children, participation in clinical trials should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with nasopharynx should have their treatment planned by a team of doctors who specialize in treating childhood cancer. Treatment is overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who specialize in treating children with cancer and who specialize in certain areas of medicine. This may include the following experts and others:

  • Pediatrician
  • Pediatric surgeon
  • Radiation Oncologist
  • Pediatric ear, nose, and throat specialist
  • Pathologist
  • Pediatric Nurse Specialist
  • Social worker
  • Rehabilitation specialist
  • Psychologist
  • Expert in child life

Four types of standard therapy are used:

Chemotherapy: Chemotherapy is the treatment of cancer using drugs to stop the growth of cancer cells by killing them or preventing them from multiplying. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and reach cancer cells throughout the body (systemic chemotherapy).

Radiotherapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other forms of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation to the area of ​​the body where the cancer is.

Surgery: Surgery to remove the tumor is done if the tumor does not spread through the nasal cavity and throat at the time of diagnosis.


Symptoms and Causes of Rheumatoid Arthritis | Orthopaedics

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis is a chronic inflammatory disorder that can impact more than just your joints. In some people, the precondition can harm a variety of body systems, including the skin, eyes, lungs, and heart, and blood vessels. An immune system issue, rheumatoid arthritis inflammation happen when your invulnerable framework erroneously assaults your body’s tissues.

In contrast to the mileage from osteoporosis, rheumatoid arthritis inflammation impacts the covering of your joints, causing agonizing expansion that can at long last prompt bone erosion and joint deformation.

The aggravation related to rheumatoid arthritis inflammation is the thing that can harm different pieces of the body too. While new kinds of drugs have greatly improved treatment options, acute rheumatoid arthritis can cause physical disabilities.

Symptoms of rheumatoid arthritis

Rheumatoid arthritis is a chronic disease characterized by symptoms of inflammation and pain in the joints. These indications and signs happen during periods known as flares or intensifications. Other times are known as periods of remission when symptoms completely disappear.

While symptoms of rheumatoid arthritis can affect several organs in the body, symptoms of rheumatoid arthritis include:

  • Joint pain
  • Joint swelling
  • Joint stiffness
  • Loss of joint function and deformities

Symptoms can vary from mild to severe. It’s significant not to disregard your manifestations, regardless of whether they travel every which way. Knowing the early signs of rheumatoid arthritis will help you and your healthcare provider better treat and manage it.

Causes of rheumatoid arthritis

RA is an autoimmune disease. Your immune system, like bacteria and viruses, is supposed to attack foreign bodies in your body by causing inflammation. In autoimmune disease, the immune system mistakenly sends inflammation to healthy tissues. The immune system causes a lot of inflammation to be sent to your joints causing joint pain and swelling.

If the inflammation persists for an extended period of time, it can damage the joint. Usually, this damage cannot be reversed once it has occurred. The cause of rheumatoid arthritis is unknown. There is evidence that autoimmune diseases run in families. For example, some of the genes you were born with may make you more likely to develop rheumatoid arthritis.

Risk factors of rheumatoid arthritis

According to the Arthritis Foundation, women get rheumatoid arthritis two to three times more often than men. In women, symptoms tend to appear between the ages of 30 and 60, while men often develop symptoms later in life. There may also be a genetic basis for the disease. Cigarette smoking and periodontitis are also risk factors.

Diagnosis of rheumatoid arthritis

In its early stages, rheumatoid arthritis can be difficult for a doctor to diagnose because it can resemble other conditions. However, early diagnosis and treatment are essential to slow disease progression. The CDC recommends an effective diagnosis and treatment strategy to begin within 6 months of symptoms appearing.

The doctor will look at the person’s clinical signs of inflammation and ask how long they have been there and how severe the symptoms are. They will also perform a physical examination to check for any swelling, functional limitations, or deformity. They might recommend some tests.

Blood tests:

  • Erythrocyte sedimentation rate (ESR or sed rate): This test measures levels of inflammation in the body. It measures how quickly red blood cells in a test tube separate from blood serum over a specified period. If the red blood cells rapidly settle into deposits, levels of inflammation are elevated. This test is not specific to RA and is a useful test for inflammatory conditions or other infections.
  • C-reactive protein (CRP): The liver produces C-reactive protein. A high CRP level indicates inflammation in the body. This test is not specific to RA and CRP can occur in inflammatory conditions or other infections.
  • Anemia: Many people with rheumatoid arthritis also have anemia. Anemia happens when there are too scarcely any red platelets in the blood. Red platelets convey oxygen to the tissues and organs of the body.
  • Rheumatoid factor: If an antibody known as a rheumatoid factor is present in the blood, it can indicate the presence of rheumatoid arthritis. However, not everyone with rheumatoid arthritis is positive for this factor.

Imaging scans and X-rays: An X-ray or MRI of the joint can help the doctor determine the type of arthritis present and monitor the progression of rheumatoid arthritis over time.

Diagnostic criteria: In 2010, the American College of Rheumatology recommended the following criteria for diagnosing rheumatoid arthritis:

  • Swelling is present in at least one joint, and it has no other cause
  • Results of at least one blood test indicate rheumatoid arthritis
  • Symptoms have been present for at least 6 weeks

Treatment for rheumatoid arthritis

The goals of treating rheumatoid arthritis are:

  • Control of patient signs and symptoms
  • Prevent joint damage
  • Maintaining the patient’s quality of life and ability to function

Joint harm, by and large, happens inside the initial two years of determination, so it is critical to analyze and treat rheumatoid joint pain in a “window of opportunity” to forestall long-haul outcomes.

Treatments for rheumatoid arthritis include medication, rest, exercise, physical therapy / occupational therapy, and surgery to correct the damage to the joint.

The type of treatment depends on many factors, including the person’s age, general health, medical history, and the severity of arthritis.

Non-pharmacologic therapies

Non-drug therapy is the first step in treatment for all people with rheumatoid arthritis. Non-drug treatments include the following:

Rest: When joints become inflamed, the risk of injuring the joint and nearby soft tissue structures (such as tendons and ligaments) is high. This is why sore joints should be relieved. However, fitness should be maintained as much as possible. Maintaining a good range of motion in your joints and good overall fitness is important in dealing with the general features of the disease.

Exercise: Pain and stiffness often cause people with rheumatoid arthritis to become lethargic. However, inactivity can lead to loss of joint mobility, cramps, and loss of muscle strength. These, in turn, reduce joint stability and increase fatigue.

Regular exercise, especially in a controlled way with the help of physical therapists and occupational therapists, can help prevent and reverse these effects. Useful exercises include a range of motion exercises to maintain and restore joint mobility; Exercises to increase strength, and; Exercises to increase endurance (walking, swimming, cycling).

Physical and occupational therapy: Physical and occupational therapy can relieve pain, reduce inflammation, and help maintain joint structure and function for rheumatoid arthritis sufferers. Certain types of treatment are used to treat specific problems of rheumatoid arthritis:

  • Heat or cold can relieve pain or stiffness
  • Ultrasound can help reduce inflammation of the sheaths surrounding the tendons (tendinitis)
  • It can improve exercise and maintain joint range of motion
  • Resting and splinting can help reduce joint pain and improve joint function
  • Finger bracing and other assistive gadgets can forestall deformations and improve handwork
  • Relaxation techniques can relieve secondary muscle spasms

Occupational therapists also focus on helping people with rheumatoid arthritis to continue to actively participate in work and leisure activities, with special attention to maintaining the good function of the hands and arms.

Nutrition and dietary therapy: Weight reduction might be prescribed for overweight and hefty individuals to diminish weight on aroused joints. People with rheumatoid arthritis are more likely to have coronary artery disease. High blood cholesterol (a danger factor for coronary supply route malady) can react to changes in diet. A nutritionist can recommend specific foods to eat or avoid in order to reach your desired cholesterol level.

Diet changes have been investigated as treatments for rheumatoid arthritis, but no diet has been proven to treat it. There are no herbal or nutritional supplements, such as cartilage or collagen, that can treat rheumatoid arthritis. These treatments can be dangerous and are not usually recommended.


There are many medications to reduce joint pain, swelling, and inflammation and prevent or slow the disease. The type of medication your doctor recommends will depend on the severity of your arthritis and how well you respond to the medications.

These include medicines:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen
  • Corticosteroids (oral and injection forms)
  • COX-2 inhibitor (celecoxib [Celebrex®])
  • Disease-modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex, Trexall), sulfasalazine, and leflunomide

It may take four to six weeks of treatment with methotrexate, one to two months with sulfasalazine, and two to three months with hydroxychloroquine to see improvement in symptoms.

  • Biological agents, such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), tocilizumab (Actemra), rituximab (Rituxan), abatacept (Orencia) ), anakinra (Kineret), tofacitinib (Xeljanz)

Biology tends to work quickly, within two weeks for some drugs and within four to six weeks for others. Biopharmaceuticals may be used alone or in combination with other disease-modifying drugs. It is usually intended for patients who do not respond adequately to DMDs, or if a patient’s disease prognosis (outlook) is a problem.

Other precautions to be noted with these medications:

  • Cancer-modifying medications and biological agents interfere with the immune system’s ability to fight infection and should not be used by people with serious infections.
  • Anti-TNF agents such as infliximab, etanercept, adalimumab, certolizumab, and golimumab are not recommended for people with lymphoma or who have been treated for lymphoma. People with rheumatoid arthritis – especially those who are very ill – have an increased risk of developing lymphoma, regardless of the treatment used. Anti-TNF agents were associated with a further increase in the risk of developing lymphoma in some studies but not in others. More research is needed to determine this risk.
  • Tuberculosis (TB) test is required before starting anti-TNF treatment. People with evidence of TB should be treated earlier than TB because there is an increased risk of developing active TB while receiving anti-TNF treatment.

Some of these medicines are traditionally used to treat other conditions, such as cancer, inflammatory bowel disease, and malaria. When these medications are used to treat rheumatoid arthritis, doses are much lower and the risks of side effects tend to be much lower. However, the risks of side effects from treatment must be weighed against the benefits on an individual basis.

Whenever you have prescribed any medication, it is important to meet your doctor regularly so that he can monitor for any side effects.


When bone damage from arthritis becomes severe or pain is not controlled with medications, surgery is an option to restore function to the damaged joint.

Complications of rheumatoid arthritis

Since rheumatoid arthritis is a systemic disease, its inflammation can impact organs and areas of the body other than the joints.

  • The inflammation of the eye and mouth glands associated with arthritis can cause dryness in these areas and is referred to as Sjogren’s syndrome. Dry eyes can erode the cornea.
  • Inflammation of the white parts of the eye (sclera) is referred to as scleritis and can be very dangerous to the eye.
  • Rheumatoid inflammation of the lining of the lung (pleuritis) causes chest pain accompanied by deep breathing, shortness of breath, or coughing. The lung tissue itself can become inflamed and scarred, and sometimes inflammatory nodules (rheumatic nodules) develop inside the lungs.
  • Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause chest pain that usually changes in intensity when lying down or bending forward.
  • Rheumatoid arthritis is associated with an increased risk of a heart attack.
  • Rheumatoid disease can decrease the number of red blood cells (anemia) and white blood cells.
  • Decreased white cells can be associated with an enlarged spleen (referred to as Felty’s syndrome) and can increase the risk of developing infections.
  • The risk of developing lymphoma (lymphoma) is higher in patients with rheumatoid arthritis, especially those with persistent active arthritis.
  • Hard lumps or hard bumps under the skin (subcutaneous nodules called rheumatic nodules) can occur around the elbows and fingers where there is repeated pressure. Although these nodules usually do not cause symptoms, they can sometimes become infected.
  • Nerves in the wrists can become pinched to cause carpal tunnel syndrome.
  • Inflammation of the blood vessels (vasculitis) is a rare serious complication, usually with chronic rheumatoid disease. Vasculitis can impair blood flow to tissues and lead to tissue death (necrosis). This often appears initially as small black areas around the nail bed or as leg sores.

Symptoms and Causes of Ewing’s Sarcoma | Orthopaedics

What is Ewing’s sarcoma?

Ewing’s sarcoma is a rare type of cancer that occurs in the bones or in the soft tissue around the bones. Ewing sarcoma most often begins in the bones of the legs and pelvis, but it can occur in any bone. Less commonly, it begins in the soft tissues of the chest, abdomen, extremities, or other locations.

Ewing sarcoma is most common in children and teens, but it can occur at any age. Major advances in the treatment of Ewing’s sarcoma have helped improve the outlook for people with this cancer. After completion of treatment, lifelong follow-up is recommended to observe possible late effects of severe chemotherapy and radiation.

Symptoms of Ewing’s sarcoma

The signs and symptoms of Ewing sarcoma include:

  • Pain, swelling, or tenderness near the affected area
  • Bone-ache
  • Unexplained tiredness
  • Fever with no known cause
  • Lose weight without trying

Types of Ewing’s sarcoma

There are numerous kinds of Ewing sarcoma, including Ewing sarcoma of bone, Ewing’s sarcoma extraosseous, peripheral primitive neuroectodermal tumor (pPNET), and Askin’s tumor. These tumors are considered related because they have similar genetic causes.

Causes of Ewing’s sarcoma

It is not clear what causes Ewing sarcoma.

Physicians know that Ewing sarcoma starts when a cell develops changes in its DNA. A cell’s DNA contains the instructions that tell the cell what to do. The changes tell the cell to multiply rapidly and to continue living when healthy cells would normally die. The result is a mass (tumor) of abnormal cells that can invade and end healthy body tissue. Abnormal cells can separate and spread (metastasize) throughout the body.

In Ewing sarcoma, DNA changes most often affect a gene called EWSR1. If your doctor suspects that you have Ewing sarcoma, your cancer cells may be tested for changes in this gene.

Risk factors of Ewing’s sarcoma

Risk factors for Ewing sarcoma include:

  • Your age: Ewing sarcoma can occur at any age, but it is more likely to occur in children and adolescents.
  • Your ancestry: Ewing sarcoma is more common in people of European descent. It is much less common in people of African and East Asian descent.

Diagnosis of Ewing sarcoma

The diagnosis of Ewing sarcoma usually begins with a physical exam to better understand the symptoms that you or your child may be experiencing. Based on those findings, other tests and procedures may be recommended.

Imaging tests: Imaging tests help your physician examine your bone symptoms, look for cancer, and look for signs that cancer has spread.

Imaging tests may include:

  • X-rays
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan

Removing a sample of cells for analysis (biopsy): A biopsy process is used to collect a sample of suspicious cells for research laboratory testing. The tests can show if the cells are cancerous and what type of cancer you have.

The types of biopsy procedures used to diagnose Ewing sarcoma include:

  • Needle biopsy: The doctor inserts a fine needle through the skin and guides it to the tumor. The needle is used to eliminate small pieces of tissue from the tumor.
  • Surgical biopsy: The doctor makes an incision through the skin and removes the entire tumor (excisional biopsy) or part of the tumor (incisional biopsy).

Determining the type of biopsy needed and the details of how it should be performed requires careful planning on the part of the medical team. Doctors must perform the biopsy in a way that does not interfere with future surgery to remove cancer. For this reason, ask your doctor for a referral to a team of experts with extensive experience treating Ewing sarcoma before your biopsy.

Cancer cell testing for genetic mutations: A sample of your cancer cells will be tested in the laboratory to determine what DNA changes are present in the cells. Ewing sarcoma cells often have changes in the EWSR1 gene. Very often, the EWSR1 gene fuses with another gene called FLI1, creating a new gene called EWS-FLI1. Testing cancer cells for these genetic changes can help confirm your diagnosis and give your doctor clues as to how aggressive your disease is.

Treatment for Ewing sarcoma

Treatment for Ewing’s sarcoma usually begins with chemotherapy. Surgery to remove cancer usually follows. In certain situations, other treatments may be used, including radiation therapy.

Chemotherapy: Chemotherapy uses powerful drugs to kill cancer cells. Chemotherapy treatment usually combines two or more drugs that can be given as an infusion into a vein (IV), as a pill, or by both methods. Treatment for Ewing’s sarcoma usually begins with chemotherapy. Medications can shrink the tumor and make it easier to remove cancer with surgery or target it with radiation therapy.

After surgery or radiation therapy, chemotherapy treatments can continue to kill any cancer cells that may remain. For advanced cancer that has spread to other areas of the body, chemotherapy can help relieve pain and slow the growth of cancer.

Surgery: The goal of surgery is to kill all cancer cells. But the planning of the operation also takes into account how it will affect your ability to carry out your daily life.

Surgery for Ewing sarcoma may involve the removal of a small piece of bone or the removal of an entire limb. Whether surgeons can eliminate all of the cancer without removing the entire limb rest on several factors, such as the size and locality of the tumor and whether it shrinks after chemotherapy.

Radiotherapy: Radiation therapy usages high-energy beams, such as x-rays and protons, to kill cancer cells. During radiation therapy, beams of energy are sent from a machine that moves around you as you lie on a table. The rays are carefully aimed at the area of ​​Ewing’s sarcoma to reduce the risk of damage to surrounding healthy cells.

Radiation therapy may be recommended after surgery to kill any remaining cancer cells. It can also be used instead of surgery if Ewing’s sarcoma is in a part of the body where surgery is not possible or would lead to unacceptable functional results (such as loss of bowel or bladder function).

For advanced Ewing sarcomas, radiation therapy can deliberate the growth of cancer and help dismiss the pain.

Complications of Ewing’s sarcoma

Complications of Ewing sarcoma and its treatment include:

  • Cancer that spreads (metastasizes): Ewing’s sarcoma can spread from where it started to other areas, making treatment and recovery difficult. Ewing’s sarcoma most often spreads to the lungs and other bones.
  • Long-term side effects of treatment: The aggressive treatments needed to control Ewing sarcoma can cause substantial side effects, both short and long term. Your healthcare team can help you monitor the side effects that occur during treatment and provide you with a list of side effects to watch for in the years after treatment.

Prevention of Ewing’s sarcoma

While it is always good to maintain a healthy weight and stop smoking or using tobacco, there are currently no known lifestyle changes that can prevent Ewing sarcoma.


Symptoms and Types of Ankle Arthritis | Orthopaedics

What is ankle arthritis?

Arthritis is a common term for a group of more than 100 diseases. The word “arthritis” means “inflammation of the joints.” Arthritis involves inflammation (swelling) in and around the joints. The inflammation can cause pain, stiffness, and swelling. Arthritis is an acute or chronic inflammation of the soft tissues of the joint and its surroundings.

In arthritis, progressive joint degeneration occurs and the soft “cushion” cartilage in the joints gradually disappears, causing the bones to wear down each other. The soft tissue in the joints also begins to wear out. Arthritis can be painful and eventually lead to limited mobility, loss of joint function, and joint deformities.

As you get older, your risk of developing arthritis will increase. Joint damage caused by this condition can cause swelling, pain, and physical changes in the feet and ankles.

Symptoms of ankle arthritis

 Symptoms of foot and ankle arthritis are usually:

  • Tenderness when touching the joint
  • Pain when you move it
  • Difficulty moving, walking, or putting weight on it.
  • Stiffness, warmth, or swelling of the joints
  • More pain and swelling when sitting or falling asleep after resting

Types of ankle arthritis

Arthritis is a common term for a group of more than 100 diseases. It can cause inflammation and swelling in the joints and surrounding soft tissues.

With many types of arthritis, your joints wear out over time. You will gradually lose the soft “cushion” cartilage within them. As a result, your bones rub against each other and wear out. The soft tissue in the joints also begins to wear out. After a while, the joint may not work or may not move as it should.

Several types of arthritis can cause pain in the feet and ankles, including:

Osteoarthritis, or “wear and tear” arthritis, is the most common type. Doctors also call it a degenerative joint disease or age-related arthritis. Osteoarthritis usually causes changes over many years. These are the most common foot and ankle joints:

  • The three joints of the heel bone, the inner midfoot bone, and the outer mid-foot bone.
  • The toe joint and foot bone.
  • The joint where the ankle and tibia meet.
  • Rheumatoid arthritis is one of the most serious forms. It is an autoimmune disease in which your immune system attacks the joint. It usually occurs in the same joint on both sides of your body.
  • Gout occurs when uric acid builds up in your diet. It is most common in the toe because it is the most distant part of the body from the heart.
  • Psoriatic arthritis can occur in one or more joints, including the ankles and toes. It can also cause an inflammation of the toes called dactylitis.
  • Post-traumatic arthritis occurs after an injury, especially after a dislocation or fracture. You may not notice problems for years.

Diagnosis of ankle arthritis

Doctors can often diagnose RA with a physical exam. They visually inspect the ankles for swelling or other signs and examine their range of motion.

Doctors primarily diagnose rheumatoid arthritis (RA)based on symptoms, but may also recommend other tests to get better details.

For example, doctors often recommend X-rays, ultrasounds, or sometimes MRIs to assess the extent and location of joint damage. This is higher when the doctor suspects RA in the ankle because the initial damage is more immediately apparent than in other areas.

Blood tests can help determine if antibodies in the blood indicate RA or have ruled out other conditions.

Treatment for ankle arthritis

Depending on your symptoms and the cause of your ankle arthritis, you may receive one or more of these treatments:

  • Steroids are injected into the joints
  • Anti-inflammatory drugs that help with inflammation
  • Analgesics
  • Supports pads or arch on your shoes
  • Cane or support braces
  • Shoe inserts that support the ankle and foot (orthotics)
  • Physical therapy
  • Custom footwear
  • Surgery for foot and ankle arthritis

Some people need at least one type of surgery to treat foot and ankle arthritis. Your doctor will prescribe the best treatment for you. Arthritis surgeries:

Fusion surgery: This is also known as arthrodesis. Fix the bones with rods, pins, screws, or plates. Once they heal, the bones stick together.

Joint replacement surgery: It is used mainly in severe cases. Your doctor will call it an arthroplasty. They remove damaged bone and cartilage and replace them with metal or plastic.

Home remedies for ankle arthritis

When you have arthritis in your foot or ankle, it is very important to wear comfortable shoes. Check out these details:

  • Shoes are shaped like your foot
  • Supportive shoes (for example, no slip-on shoes)
  • Rubber soles for cushioning
  • Flexibility
  • Proper fit; Ask the seller for help
  • Exercise helps keep your feet strong, straight, and painless. Good moves for your feet

Achilles stretch: Flatten with your palms against the wall. Take one step forward and one step back. Keep your heels on the ground and move forward. Pull the Achilles tendon on the back leg and calf. Hold for 10 seconds. Do this exercise three times on each side.

Big toe stretch: Put a thick rubber band around the big toe. Pull your muscles toward each other and the other leg. Hold this position for 5 seconds. Do it 10 times.

Pull the toe: Put a rubber band around the ball of each foot and extend your leg. Hold this position for 5 seconds and do the exercise 10 times.

Finger flexion: Remove the marbles with your foot.

Other home remedies for ankle arthritis

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. These can cause side effects such as stomach irritation, so consult your doctor before taking them.

  • Creams that contain menthol or capsaicin, which can prevent nerves from sending pain signals
  • Keep the area warm or cold
  • Acupuncture
  • Glucosamine and chondroitin medications
  • Gentle exercises like yoga, tai chi
  • Massage

Medications: It is very important to reduce inflammation so that a person can limit the inflammation in their ankles and control their pain. The following medications can help with RA symptoms and reduce chronic joint damage:

  • Pain relievers to control uncomfortable symptoms
  • Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
  • Disease-correcting antirheumatic drugs (DMARDs)
  • biology

Maintaining inflammation can help restore mobility to the ankle and other joints. If RA causes permanent damage to the ankle joint, medications will not reverse it, but they will help with pain, prevent further damage, and improve quality of life.

Doctors can also use corticosteroid injections in the ankle to quickly reduce acute inflammation and prevent damage or pain. Because they can suppress the immune system, people should know that they are more likely to get an infection if they take DMARDs and biologics.

Surgery: People with advanced forms of RA or people who do not respond well enough to treatment may need surgery. The surgery doctors offer depends on the type of arthritis and the extent of the damage. Some surgeries involve massaging the bones of the ankle to prevent inflammation and pain.

Ankle replacement surgery may be an option to reduce pain and restore joint mobility in more severe cases if fusion is not effective.

Lifestyle Changes for Foot Arthritis: Some changes in your daily life can make you feel better and prevent your arthritis from getting worse. If a specific activity triggers inflammation, try to keep it to a minimum. Instead of high-impact exercises like jogging, do less spin like swimming or biking. Maintain a healthy weight to put more stress on your joints.


Symptoms and Prevention of Eardrum Rupture | ENT Specialist

What is eardrum rupture?

Eardrum Rupture (tympanic membrane perforation) is a hole or tear in the thin tissue that separates the ear canal from the middle ear (eardrum). An eardrum is a small hole or tears in the eardrum or tympanic membrane. The tympanic membrane is the thin tissue that separates the middle ear and the external auditory canal.

This membrane vibrates when sound waves enter your ear. The vibration continues through the bones of the middle ear. Since this vibration allows you to hear, your hearing will be damaged if your hearing is damaged. A cracked eardrum can lead to hearing loss. This can lead to middle ear infections. A ruptured eardrum is also known as a perforated eardrum. In rare cases, this condition can cause permanent hearing loss.

Symptoms of an eardrum rupture

Some people do not notice the symptoms of an eardrum rupture. Others see their doctor only after several days of general ear discomfort and feel that “something is wrong with the ear.” Some people are surprised to hear air coming out of the ear when the nose is blown. Forcing the nose will make the air rise to fill the space in the middle ear.

Usually, it becomes a balloon that comes out of the eardrum. But if there is a hole in the ear, the air will run out. Sometimes the noise is enough for other people to hear it.

Other symptoms of an eardrum rupture:

  • Sudden sharp earache or sudden decrease in earache
  • Drainage from the ear is hemorrhagic, clear, or pus-like
  • Noise or ear noise
  • Partial or total hearing loss in the affected ear
  • Episodic ear infection
  • Facial weakness or dizziness

Causes of eardrum rupture

Infection: An ear infection is a common cause of ear infections, especially in children. During an ear infection, fluids collect behind the ear canal. The pressure of fluid retention can cause the tympanic membrane to rupture or rupture.

Stress swings: Other activities can cause pressure changes in the ear and lead to a piercing earache. This is called barotrauma and it occurs when the pressure outside the ear is very different from the pressure inside the ear. Actions that can cause barotrauma:

  • Scuba diving
  • Flying in a plane
  • Driving at high altitudes
  • Shock waves
  • Direct and powerful effect on the ear
  • Injury

Injuries can also perforate the eardrum. Any injury to the ear or head can lead to a rupture. The following are the causes of deafness:

  • Pounding in the ear
  • Tolerance to injury during sports
  • Falling into your ear
  • Car accidents

Inserting any object, such as a cotton swab, fingernail, or pen too far into the ear, can also damage the eardrum. Noise injuries, or hearing damage from very loud noises, can cause eardrum rupture. However, these cases are not that common.

Diagnosis of eardrum rupture

Your doctor can use several ways to find out if you have a cleft palate:

  • A fluid sample, in which your doctor tests the fluid leaking from the ear for infection (infection can cause the eardrum to rupture)
  • An otoscope exam, in which your doctor uses a special lighted device to look into your ear canal.
  • Audiology test, in which your doctor assesses your hearing range and deafness
  • Tympanometry, in which your doctor inserts a manometer into your ear to assess your deafness response to pressure changes.
  • Your doctor may refer you to an otolaryngologist or if you need more specific tests or treatment for a ruptured eardrum.

Treatment for eardrum rupture

Treatments for deafness are primarily designed to reduce pain and eliminate or prevent infections.

Patching: If your ear doesn’t heal on its own, your doctor can prevent earache. Patching is the placement of a medical paper patch over a tear in the membrane. The patch layer promotes regrowth together.

Antibiotics: The antibiotics will kill the infections that caused the ear to break. They protect you from getting new piercing infections. Your doctor may prescribe oral antibiotics or pending outdated medications. You may also be told to use both types of medicine.

Surgery: In rare cases, surgery may be required to repair the hole in the eardrum. Surgical repair of a pierced ear is called tympanoplasty. During a tympanoplasty, your surgeon will take tissue from another area of ​​your body and place it in the hole in your ear.

Home remedies: At home, you can reduce cracked eardrum pain with pain relievers and heat. Putting a warm, dry compress on your ear every day helps. Encourage healing without making your nose more than necessary. Blowing your nose creates pressure in your ears.

Holding your breath, plugging your nose, and trying to clear your ears by swallowing can also create excessive pressure in your ears. Increased stress can be painful and will cure your earache. Don’t wear over-the-counter earrings unless your doctor recommends them. If your eardrum ruptures, the fluid from these droplets will fall deeper into your ear. This causes more problems.

Deafness in children: Eardrum ruptures in children are very common due to soft tissue and narrow ear canals. Using too much of a cotton swab can easily damage a child’s eardrum. Even small foreign objects, such as a pencil or hairpin, can damage or puncture the eardrum if they are inserted too far into the ear canal.

Ear infections are the most common cause of ear infections in children. Five out of 6 children will have at least one ear infection by the age of 3. If your group of babies spends time in daycare or bottle-feeding while the mother sleeps instead of breastfeeding, your baby’s risk of infection is higher.

See your pediatrician as soon as you notice the following symptoms:

  • Mild to severe pain
  • Hemorrhagic or pus-filled discharge from the ear
  • Persistent nausea, vomiting, or dizziness
  • Ringing in the ears

Take your child to an otolaryngologist if your doctor is concerned that your child’s broken ear may require additional care.

Because your child’s earrings are sensitive, untreated damage can have long-term effects on their hearing. Teach your child not to put objects in her ears. Also, if your child has a cold or sinus infection, try to keep him flying. Changes in stress can damage your ears.

  • If you have an ear infection, seek treatment right away
  • When you have a cold or sinus infection, try flying on airplanes
  • Wear earplugs to stabilize the pressure in your ears, chew gum, or force a yawn
  • Do not use foreign objects to clean excess earwax (daily showering is enough to keep)

Recovery from eardrum rupture

Your tympanic membrane has two main functions:

Listening: When sound waves touch you, your eardrum vibrates. The structure of your middle and inner ear is the first step in translating sound waves into nerve impulses.

Protection: Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria, and other foreign substances. If your eardrum is ruptured, unusual problems can occur, especially if it doesn’t heal after three to six months.

Some possible problems:

Hearing loss: Hearing loss is usually temporary and lasts until the tear or hole in the ear has healed. The size and location of the tear can affect the degree of hearing loss.

Middle ear infection (otitis media): A torn (stitched) earlobe can allow bacteria to enter the ear. If penetrating deafness is not cured, a small number of people will develop chronic infections (recurrent or chronic). In this small group, chronic drainage and hearing loss can occur.

Middle ear cyst (cholesteatoma): Although very rare, this cyst, which consists of skin cells and other debris, develops as a long-term result of deafness.

The debris from the ear canal usually travels to the outer ear with the help of wax. If there are cracks in the ear, debris can enter the middle ear and form a cyst.

A cyst in your middle ear provides a friendly environment for bacteria and contains proteins that can damage the bones of your middle ear.

Prevention of eardrum rupture

Follow these tips to prevent eardrum rupture:

Get treatment for eardrum rupture. Know the signs and symptoms of an eardrum rupture, such as fever, nasal, ear congestion, and hearing loss. Children with middle ear infections are often confused and may refuse to eat. Get a quick evaluation from your primary care doctor to avoid possible damage to the eardrum.

Protect your ears during the flight. If possible, have a runny nose or ear if you have a cold or active allergy. During takeoffs and landings, keep your ears clear with earplugs, anvils, or similar pressure gum.

Use the Valsalva maneuver: Pinch your nostrils and keep your mouth closed as if air has entered your nose. Don’t sleep on the ups and downs.

Keep your ears free of foreign objects: Never attempt to remove excess hardened earwax with items such as a cotton swab, paper clip, or hairpin. These items can easily tear or puncture your eardrum. Teach your children about the damage caused by putting foreign objects in their ears.

Protect yourself from the noise of explosions: Avoid actions that expose your ears to explosions. If your hobbies or activities want to produce explosive noise at work, protect your ears from unnecessary damage by wearing earplugs or earmuffs.