ENT Clinic

Elongated Styloid Process Excision

2012-02-12T09:44:00.002+05:30

Bilateral cervical rib

2012-01-07T15:12:00.001+05:30

RE: Nose bleeding

2012-01-04T07:08:00.001+05:30

Hello,

Dryness and crusts formation which are picked by kids with fingers causes most of the bleeding from nose in children. See if your child is having cold or cough. Apply any lubricating ointment such as neosporin eye ointment just inside the nose to avoid dryness there. You can also use coconut oil for same. Rarely some serious causes may be there like blood clotting abnormality or abnormal mass or foreign body which should be ruled out if bleeding persists.

with Best Regards,

Dr. Ajay Jain

From: enquiry@doctorsinciti.com
To: drajayjain@hotmail.com
Date: Mon, 2 Jan 2012 06:48:10 -0800
Subject: Nose bleeding

Visitor Email: gupta.rajeshv@gmail.com
my son is three yers old. ha has a problem of nose bleeding. bleeding come through from nose automaticaly and it happend in sleeping time also i have taken a advise from DR in agra but there is no relief in this problem so kindly advice me.

Medical treatment of Maxillary Sinusitis

2011-12-05T13:54:00.001+05:30

Here are two images of CT scan of a person suffering from left Maxillary sinusitis. First Image depicts completely opacified maxillary sinus with adjacent ethmoid sinusits. He was treated with antibiotics, oral and topical steroids, decongestant nasal drops for six weeks. Second image shows complete resolution of sinus opacities with patent ostiomeatal complex.
So, it is essential to treat such cases medically for adequate length of time before deciding for surgery. After all Sinusitis is primarily a medical condition.

Attached is an image edited with BlackBerry Photo Editor Ultimate

ENT Clinic

2011-12-04T21:54:00.003+05:30

Bath after Adenoidectomy, Tonsillectomy or ear surgery.

2011-12-04T09:12:00.000+05:30

When can the child bath after adenotonsillectomy.?

Ans He can take bath anytime or better next morning as routine.If Myringotomy with Grommet insertion have also been undertaken then it is of utmost importance not to let water insider ear canal otherwise infection can develop. To prevent this, use cotton plug smeared with vaseline or some ointment during bath. the advantage of using vaseline is that it repels water and it keeps cotton fibers bind together so that when you remove the plug, no cotton fiber is left behind.

Leukoplakia of tongue

2011-12-04T09:05:00.000+05:30

This is a common site in India where people chew tobacco and beetle nuts.This patient had this whitish lesion on lateral part of tongue for last one year and it is progressively increasing in size.

Regarding Oral Lichen Planus

2011-12-01T09:15:00.002+05:30

Dear doctor,

I am 24 years, smoke a pack of cigarette a week(reduced, trying to quit!). I have got something unusual on my cheek(inside mouth) There is no pain feeling happening. I have visited many doctors and they say that it is nothing to worry about. But I am worried as it has been over a year since it is present on my inner cheek.

I read your post on Oral Lichen Planus and I thought you might be in better position to guide.

Please see the pictures in the attachment and give your opinion.

Thanks,

Sachin

Pediatric rhinosinusitis

2011-12-01T09:15:00.000+05:30

Case of 11 year child with history of mouth breathing having Adenotonsillar hypertrophy. Patient was not referred but came on her own very late. In our country, timely referrals from paediatrician is rare. All cases of mouth breathing should have an ENT opinion at earliest.

? Chondroma or fibrous dysplasia

2011-11-27T03:46:00.000+05:30

I recently operated this tumour. It ewas surrounded with thick wall with semisolid contents. Waiting for biopsy report. Dr Ajay Jain

Direction Map for clinic

2011-11-15T13:01:00.001+05:30

Facebook newsfeed post by: Sophie Tdz

2011-10-01T15:47:00.000+05:30

Sophie Tdz wrote:
A worried woman went to her gynecologist and said: 'Doctor, I have a serious problem and desperately need your help! My baby is not even 1 year old and I'm pregnant again. I don't want kids so close together'. So the doctor said: 'OK and what do you want me to do?
' She said: 'I want you to end my pregnancy, and I'm counting on your help with this.' The doctor thought for a little, and after some silence he said to the lady: 'I think I have a better solution for your problem. It's less dangerous for you too.' She smiled, thinking that the doctor was going to accept her request. Then he continued: 'You see, in order for you not to have to take care 2 babies at the same time, let's kill the one in your arms. This way, you could rest some before the other one is born. If we're going to kill one of them, it doesn't matter which one it is. There would be no risk for your body if you chose the one in your arms.' The lady was horrified and said: 'No doctor! How terrible! It's a crime to kill a child! 'I agree', the doctor replied. 'But you seemed to be OK with it, so I thought maybe that was the best solution.' The doctor smiled, realizing that he had made his point. He convinced the mom that there is no difference in killing a child that's already been born and one that's still in the womb. The crime is the same! If you agree, please SHARE. Together we can help save precious lives! Love says I sacrifice myself for the good of the other person. Abortion says I sacrifice the other person for the good of myself.
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which is better-Hearing Aid or Cochlear implant

2011-09-28T22:02:00.000+05:30

In a Case of deaf child, cochlear implant is indicated only if hearing aid does not work at all.
If a child is getting benefited by HA and. She is achieving comprehensible and spoken speech. Then no need for CI. Parents and her audiologist can better judge for improvement.

Which Steroids

2011-09-28T21:59:00.000+05:30

What extra advantage Methylprednisolone has over prednisolone for sudden SNHL or Indirect Optic nerve injury.
Fact is Methylprednisolone is only marginally potent than prednisolone. Dexamethasone and betamethasone are 5 times potent than methylprednisolone. So then why not dexa or betamethasone espl when later have zero mineralocorticoid activity and hence less fluid retention.

Attacking Docs Non-bailable Offense in Maharashtra

2011-09-22T23:03:00.004+05:30

The Maharashtra assembly has passed the Maharashtra Medicare Service Persons and Medicare Service Institution (Prevention of Violence and Damage or Loss to Property) Act, 2010 on Friday.

Under the provisions of the act, any attack on doctors or medicare service personnel would result in a fine of Rs 50,000 and a three-year jail term. Minister of State for Law and Justice Bhaskar Jadhav tabled the bill, which states, "Any offender, who commits or attempts to commit or abets or incites the commission of any act of violence....shall be punished with imprisonment which may be extended to three years and with fine, which may extend to Rs.50,000."
It is a non-bailable offense and any attacker will have to pay twice the damages for any loss caused by the said attack.
The Indian Medical Association and several other doctors' associations had demanded such a law after attacks on doctors last year.

Bruxism (Grinding of Teeth)

2011-09-19T18:56:00.000+05:30

Grinding of teeth is a topic of concern to parents. This commonly occurs in children or because of any drug which increases serotinin in brain. Increased serotinin leads to anxiety.

Grinding of teeth occurs during stage 2 of non rapid eye movement NREM sleep.

Treatment consists of reducing the anxiety and giving preventing oral appliance in consultation with dentist to prevent damage to teeth.

Soon, six months jail for disclosing the health status of a person

2011-09-17T16:27:00.002+05:30

Soon, six months jail for disclosing the health status of a person

As per the new proposed Right to Privacy Bill, doctors and hospitals cannot disclose the health status of a person. If they do, they could face imprisonment up to six months and/or a fine of up to Rs 1 lakh.

In the Bill, bugging someone's office or residence, or illegally intercepting telephone calls is being made a serious offence attracting up to five years of imprisonment and a fine of Rs 1 lakh. The Bill defines right to privacy and includes in it confidentiality of communication, family life, bank and health records, protection of honour and good name and protection from use of photographs, fingerprints, DNA samples and other samples taken at police stations and other places.

The Bill also moots the establishment of a Data Protection Authority of India that will investigate complaints about alleged violations of data protection.

Leaking information is also a professional misconduct in MCI Act. As per Medical Council of India Code of Ethics Section Clause 7.14, "The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his/her profession except – i) in a court of law under orders of the Presiding Judge; ii) in circumstances where there is a serious and identified risk to a specific person and/or community; and iii) notifiable diseases. In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately." However, the MCI Act does not define all secrets of patient.

This is equally true in America. As per American Medical Association Code of Ethics (Opinion 5.05) "The information disclosed to a physician by a patient should be held in confidence. The patient should feel free to make a full disclosure of information to the physician in order that the physician may most effectively provide needed services. The patient should be able to make this disclosure with the knowledge that the physician will respect the confidential nature of the communication. The physician should not reveal confidential information without the express consent of the patient, subject to certain exceptions which are ethically justified because of overriding considerations.

When a patient threatens to inflict serious physical harm to another person or to him or herself and there is a reasonable probability that the patient may carry out the threat, the physician should take reasonable precautions for the protection of the intended victim, which may include notification of law enforcement authorities. When the disclosure of the confidential information is required by the law or the court, it is the duty of the doctor to inform the patient about the same.

When a doctor is summoned by the court, he or she should disclose the minimal information required by the law and not volunteer additional information.

The AMA Code of Ethics Opinion 5.051 also talks about confidentiality of medical information after death. As per their ethics, the law does change about confidential information where the person is alive or death. Even the post mortem report is confidential information and should not be leaked to any unauthorized relation of the patient. It is the duty of the doctor who is treating a patient to ask the patient about possible names to whom he can disclose about his sickness and to what extent. In the Prabha Manchanda case, Supreme Court of India has clearly decided that even a mother has no right to give extended consent for her daughter who happens to be under anesthesia. In America, confidentiality is defined under the HIPAA Privacy Act.

The privacy rules require a doctor to make reasonable efforts to limit the amount of protected health information of the doctor used or disclosed to the minimum amount that is necessary to accomplish purpose of use or disclosure. Under the HIPAA Private Rules, a hospital is not supposed to announce the name of a patient in the OT list containing the name of a person in open or accessible to the public or disclose any information by which a third person may be able to know that a particular person is undergoing surgery or a medical treatment in the hospital. In no way the diagnosis or reasons of the disease should be disclosed to an unauthorized relation or a person. A doctor should not share the patient information with the patient's family or friends if the patient has asked the doctor not to or if the treating doctor believes, in his or her professional judgment, the disclosure would be inappropriate.

The privacy rules, however, allow the doctor to share patient's information with the patient's family members or friends so long the information is limited, the information directly relevant to that person's involvement in patient's care. For example, a doctor may tell a person living with the patient that the patient needs plenty of rest and lots of fluids or that the patient need to be checked twice daily.
A doctor is not supposed to share more information than the person needs to assist with the patient's care.

HIPAA also prohibits doctor providing patient's list to any representative or a device provider as this would automatically leak the patient's disease condition to an unwanted person.

MCI Act (1.3) also talks about maintenance of medical records:

1.3.1 Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.

1.3.2. If any request is made for medical records either by the patients / authorized attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.

The Act also clarifies that the records can only be given to the patient of the authorized attendant or legal authorities.

Hearing problem

2011-09-16T10:01:00.000+05:30

sir i am saying DS chandel , sir jab se ear ka bahna band ho gaya hai tab se hearing problem jyada ho gayee hai , sir whai i do
good night sir

Hi
It happens that you hear better sometimes when ear is discharging as pus forms temporary contact between sound conducting structures. I shall suggest you to show ENT doctor who will assess damage ang may advise you to undergo surgery .. Dr Ajay Jain

Tubercular Abscess

2011-09-03T15:46:00.001+05:30

Keratosis Pharyngeus

2011-08-20T20:22:00.002+05:30

Whitish spicules due to hyperkeratinized areas of epithelium are sometimes extensive over tonsils and lingual tonsils. It is usually a chance finding. No treatment is required for this condition unless it is associated with tonsillitis.
(Look at both the tonsils having whitish spicules. Interestingly this girl had same thing over base of tongue also. I advised frequent gargles only)

Telephonic consultation

2011-08-20T19:32:00.004+05:30

Very true Dr Ajay.

I never encourage my patients to call for consultation. I would rather insist them to consult me physically. I may/may not charge them but at least I know what I'm dealing with.
Sach, trend is such that a lot of people will enroll in such services in time to come for various reasons but you don't indulge into it. :)

Best Regards,
Dr Vimal Hemani

Date: Sat, 20 Aug 2011 13:46:00

Subject: Telephonic consultation

Consulting a doctor just over phone is fraught with inherent dangers and non productive to both parties. Please do not encourage this practice.

Dr Ajay Jain
MS (PGI, Chandigarh), DNB
Consultant Otorhinolaryngology & Head Neck Surgery.
Sent from BlackBerry® on Airtel

-----Original Message-----
From: Sachin Jain
Date: Sat, 20 Aug 2011 13:23:57

Subject: Dialurdoctor.com

FYI
Thanks,
Sachin Jain

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Submandibular Calculi

2011-08-18T07:22:00.002+05:30

This is a special X Ray called Occlusal view where X ray film is kept in mouth and beam is aimed from below.

Unilateral Pansinusitis

2011-08-17T16:45:00.003+05:30

This patient presented with six month history of gradually progressing nasal obstruction. CT shows complete opacification of left side sinuses. Soft tissue cuts were suggestive of Fungal mass because of heterogeneous opacities. To my surprise, it was just thick secretions in Frontal, ethmoid and sphenoid sinus. The nose and maxillary sinus was filled up with very thick walled mass with secretions inside.
Lesson: Thick secretions can mimick as fungal mass.

Concha Bullosa

2011-07-28T15:32:00.000+05:30


Bilateral large Concha Bullosa

Concha Bullosa means when the middle turbinate contains air or it is opened instead of like the inferior one as shown. It may not cause any problem or it may cause narrowing of sinus passage. It may be cause of headache especially in allergic cases. Treatment is straightforward. Excise the lateral half of this turbinate facing the sinus with help of endoscope and preserving its mucosa.

common tongue picture without any symptoms.

2011-07-12T17:19:00.002+05:30

What are these? are these hypertrohied taste buds?