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prathameshentclinic · 3 years

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DO YOU KNOW THAT A CHANGE IN YOUR VOICE CAN BE A SIGN OF LARYNGEAL CANCER?By : Dr. Amrapali Pawar

Hoarse voice, if it persists for more than 3 weeks , certainly needs to be evaluated as it can be a sign of laryngeal cancer or cancer of your voice box. But no need to panic! Just because your voice has changed its quality , it does not necessarily indicate that you have cancer. Other reasons why your voice may change or become hoarse are – laryngitis (inflammation of larynx), overuse or misuse of voice , acid reflux, allergies, trauma. So how do you know what has actually caused that change in your voice? For this you need to be properly evaluated by your ENT doctor who will infer from a proper and detailed history and examination, and if necessary , relevant investigations; your accurate diagnosis. He may need to do your laryngeal endoscopy to visualise and evaluate your voice box and surrounding structures. An examination of your neck to look for any enlarged lymph nodes, which may again be a sign of cancer is mandatory. If necessary, your ENT doctor will advise further investigations like a CT scan and / or biopsy. Although , most of the time , it is possible that your change of voice may be due to completely benign reasons which are stated above ; and if so, you will be prescribed some medications for your condition. If necessary, you will also be advised to undergo voice therapy for the same. The important thing to remember here is that- if at all you are suffering from a change of voice, please be sure to visit your ENT surgeon and get your condition diagnosed as soon as possible to avoid further complications. Any disease diagnosed in the early stage has the highest chance of recovery. The incidence of laryngeal cancer worldwide currently is 2.76 cases per year per one lakh inhabitants and 1.66 deaths per year per one lakh inhabitants . In India , laryngeal cancer contributes to approximately 3% -6% of all cancers in men. It is one of the 10 leading causes of cancer in Indian men. The 5 year survival rate for laryngeal cancer in India is approximately 28%. The factors most often implicated in the causation of laryngeal cancer according to Indian studies are : Smoking, alcohol consumption, tobacco, long term exposure to indoor air pollution ( from coal/ wood burning ) , spicy food . According to research more than 60% of laryngeal squamous cell carcinoma patients were cigarette smokers and nearly 75% of them had smoked for more than 30 years. In more than 75% of cases there was history of alcohol consumption. Change of voice or hoarse voice is not the only symptom of cancer of the larynx. Some of the patients also present with difficulty in swallowing, lump or swelling in the neck , weight loss, some even present with extreme pain in the ear (also known as referred nostalgia), in severe cases patients may present with difficulty in breathing. Depending on the stage and type of cancer , it can be treated by surgery (laryngectomy) , radiotherapy , chemotherapy or a combination of the above modalities of treatment. As stressed earlier, the management of laryngeal cancer is easier and the prognosis better if diagnosed early.

Is Your Morning Coffee Interfering With The Absorption Of Your Thyroid Supplement?By : Dr. Amrapali Pawar

For many of us, the day cannot start without your morning dose of Java! And why shouldn’t it? We all require the caffeine to overcome that morning drowsiness and make us alert to the long day ahead of us! Apart from the boost that it gives us we justify the morning cup and several cups thereafter with a list of its benefits like its fat-burning quality, essential nutrients like vitamin B2, vitamin B5, magnesium and potassium, some studies say it reduces the risk of type 2 diabetes, contains antioxidants etc.etc. Because of all these reasons having that morning joe has become a routine part of our life as soon as we wake up just like brushing your teeth, or having a bath. Hence when we are affected with thyroid problems at some point in our life and have to take life long supplements, we fail to realize the big hurdle in the absorption of our thyroid medication simply because the thought does not cross our mind! Taking coffee within an hour of taking your thyroid supplement can reduce the absorption of your medication and thus makes it less effective. Caffeine in coffee is known to increase the intestinal motility i.e. it can increase the movement of your intestines. This makes your oral medication of thyroid supplement to pass through your intestines rapidly thus leading to decreased absorption. And since the prescribed dose is less absorbed, it obviously increases your chance of developing hypothyroidism. Coffee also inhibits the conversion and absorption of the thyroid hormone and as such is not considered good for your thyroid health. Hence coffee should be taken at least an hour or later than your daily thyroid supplement. Likewise, you have to keep in mind that fiber-rich foods, calcium supplements such as calcium carbonate and iron supplements such as ferrous sulfate can interfere with the absorption of your thyroid medication, and this effect can last longer than an hour. Hence the schedule of these drugs should be adjusted after consultation with your ENT doctor or your endocrine specialist. Calcium and Iron supplements in a patient with hypothyroidism should be taken at least 4 hours after taking thyroid supplements. Commonly used antacids like proton pump inhibitors can also interfere with the absorption of thyroid supplements. Remember that thyroid supplement interacts with minerals such as iron, calcium, and magnesium. Any supplements which contain these can lower the activity of your thyroid medicine. Supplements of herbal preparation like Ashwagandha and Bladderwrack used for a variety of problems like obesity, insomnia, dementia, etc. may contain dangerous levels of iodine and need to be definitely avoided if you are on thyroid supplement. This article is for all those who are regular in taking their thyroid supplement but are wondering why it is still not under control. This is for persons with hypothyroidism taking thyroid supplements to ensure that their thyroid health is not affected by the simple medication that they might sometimes be put on, ignorant of the effect these might have on their thyroid hormone levels. So, in conclusion, patients of hypothyroidism on thyroid supplement can definitely enjoy their morning cup of coffee ...they should just remember to space it adequately after their thyroid supplement.

Can HPV Vaccination Prevent Head (Neck Cancers)By : Dr. Amrapali Pawar

What is HPV? HPV is Human Papilloma Virus and infection with the same is responsible for the development of genital warts , warts in the throat (recurrent respiratory papillomatosis), warts in the oral cavity (are uncommonly seen) but HPV infection here may manifest as mucosal hyperplasia. Many times these infections with HPV show absolutely no signs and symptoms but these persons still can transmit the infection. The type of HPV infection occurred depends on the strain of the HPV virus with which the person is infected. A person who has contracted a HPV infection is prone to development of cancer in that area. Studies have shown that about 14 million people including teens become infected with HPV every year. Many amongst these are prone to cancers caused by HPV infection. Screening tests are available for cervical cancer ( HPV related) for women . However no such screening tests are available for other cancers caused by HPV infection like cancers of the mouth and throat, cancer of anus, rectum, penis, vagina and vulva. Who should get HPV vaccination? • Recommended for preteens i.e. boys and girls at the age of 11–12 years. This ensures protection from the virus long before they are exposed to it or before they start being sexually active. Also young adults respond better to the vaccine than older ones. Vaccination given at this age requires only 2 doses as compared to three if given at a later age. • If they have missed the dose in their preteens , young men and women can be vaccinated till the age of 27yrs. The FDA (Federal Drug Authority) has approved HPV vaccination for males and females through age of 45 years but the ACIP (American Committee on Immunisation Practices) does not recommend routine vaccination after the age of 27 years as the effectiveness is questionable Ideally , HPV Vaccine should be administered before potential exposure to HPV through sexual contact. Are these vaccines easily available? These Vaccines are available with your Paediatrician, Gynaecologist, or ENT doctor and you can ask them for the same. For further information call us or email us at [email protected]

If i am Gaining Weight, is it because i have a Thyroid Problem?By : Dr. Amrapali Pawar

Not necessarily. There are many causes of weight gain like lack of exercise i.e. having a sedentary life style, improper dietary habits, regular intake of junk food or processed food, certain metabolic diseases, genetic makeup, leptin resisitance and many more. Thyroid hormone abnormality like hypothyroidism i.e. 1. Decrease in the production of thyroid hormones by the thyroid gland can cause you to gain weight. The weight gain is generally unexplainable and occurs inspite of a decreased appetite. 2. It is associated with other symptoms also like fatigue, muscle weakness or muscle aches, feeling sluggish 3. Sensitivity to cold 4. In females, there may be menstrual irregularities 5. Skin can be dry and itchy and there can be hair loss 6.Other symptoms like feeling depressed, constipation or decrease in concentration can also be noted. On the other hand, increase in the production of thyroid hormone known as hyper- thyroidism can cause you to lose weight inspite of an increase in appetite.

When is a Tonsillectomy Necessary?By : Dr. Amrapali Pawar

Tonsils are lymphoid tissues in the oral cavity which provide immunity in children till the age of 5 years. Inflammation of infection of these tissues is known commonly as Tonsillitis. Acute phase of this infection, known as acute Tonsillitis causes symptoms like pain in throat, difficulty in swallowing and fever and can be conventionally treated by antibiotics and anti-inflammatory agents. If these attacks of acute tonsillitis occur again and again, we call it Recurrent tonsillitis. If a person suffers from recurrent attacks of acute tonsillitis in a year for more than 2 years, we can say he is suffering from Chronic Tonsillitis.So how does the doctor decide that a person requires a Tonsillectomy? Tonsillectomy is done for a case of CHRONIC TONSILLITIS which means – “ If a person gets 3 or more attacks of acute tonsillitis for 2 or more consecutive years” What are the signs of chronic tonsillitis? The signs that your otolaryngologist looks for if he is suspecting a patient to be having chronic tonsillitis are – 1. Enlarged Jugulodigastric lymph nodes (these are lymph nodes present at the angle of jaw on either side) 2. congestion of anterior pillar ( the membranous structure in front of the the tonsils) 3. Enlarged / fibrosed tonsils Tonsillectomy is also performed 4-6 weeks after a case of PERITONSILLAR ABSCESS to prevent recurrence of the same. Peritosillar abscess or QUINSY is a condition or complication of acute tonsillitis in which pus collects in the tissues surrounding the tonsil and can cause severe symptoms of difficulty in swallowing , trismus ( difficulty in opening the jaw) , pain in throat and fever. Tonsillectomy is also indicated in cases of severly HYPERTROPHIC TONSILS (“KISSING TONSILS”) which actually meet in the midline and obstruct swallowing. Also in cases of SECRETORY OTITIS MEDIA (fluid collection in the middle ear) or ACUTE AND CHRONIC OTITIS MEDIA in children below the age of 12 yrs, Tonsillectomy is recommended as part of the treatment to reduce the attack of upper respiratory tract infection and prevent recurrence and halt progress of the disease. In adults , Tonsillectomy can be done as a part of surgery for OBSTRUCTIVE SLEEP APNEA and TONSILLAR CANCER.

What Causes Hoarseness of Voice/Change of Voice?By : Dr. Amrapali Pawar

Voice is produced by vibration of your vocal cords or vocal folds, which are membranous band like tissues inside your voice box. Whenever these are affected by trauma, infection or tumor or when the nerve supplying them is damaged, your voice changes quality or becomes hoarse. Causes of hoarseness of voice are cited below: 1. Acute or chronic laryngitis – acute or chronic inflammation of the vocal cords due bacterial or viral infection. 2. Overuse or misuse of voice – shouting or singing in a loud voice can cause trauma to the delicate vocal cords and cause a hoarse voice. Speaking in a high pitch for a long period of time e.g. teachers, speakers can damage the vocal cords. 3. Swellings or benign cysts, polyps or nodules of the vocal cords are common causes of voice change. 4. Cancerous tumors of the vocal cords are a cause of hoarseness and should be evaluated properly for early detection of the disease. 5. Chronic systemic conditions like Gastro esophageal reflux disease, allergies, some thyroid disorders can cause hoarseness. 6. Smoking can affect the vocal cords and cause voice change. 7. Neurological conditions can cause paralysis of one vocal cord and can cause hoarseness. If both the vocal cords are affected then person will have difficulty in breathing too. Tips to improve vocal hygiene: 1. Voice rest – if your voice is affected, giving it complete rest i.e. not speaking will recover them faster 2. Do not shout or whisper- we all know that shouting causes trauma to the vocal folds but note that whispering is also similarly traumatic and can damage these delicate structures. 3. Hydrate the throat. Drink plenty of fluids. Also if your occupation entails speaking for a long period of time, have sips of water every 15 -20 minutes which will lubricate and protect your vocal cords 4. Treatment of acid reflux- if you tend to suffer from acid reflux, get it treated as reflux can contribute to or even exacerbate voice problems 5. Stop smoking – the relation between smoking and laryngeal cancer is well known but smoking can also cause respiratory diseases, which can lead to hoarseness of voice. 6. Avoid excess alcohol – alcohol has a drying effect on mucosal lining of tissues and also contribute to acid reflux which can affect vocal health 7. Stop that compulsive practice of ‘throat clearing’. 8. Maintain a good posture –Slouching over your desk for extensive hours can in the long run affect the respiratory system. This in turn leads to a weak or hoarse voice. Also cradling the phone between your shoulder and ear is not recommended for the same reason. If your job entails having to use the phone often and for a prolonged period, then it is advised you switch to a headset. 9. Do NOT gargle – if you are experiencing voice problems gargling will further cause trauma to your vocal cords. You can sip on warm liquids instead. These will hydrate the vocal cords and provide steam to soothe them. Conclusion: If conservative management to treat hoarseness of voice caused by benign pathology fails, vocal cord surgery also known as Microlaryngeal surgery maybe required. It is best to visit an ENT surgeon to get an opinion about this condition. The well-known otolaryngologist in Mumbai, Dr Amrapali Pawar, has been treating patients for over 15 years to address this ailment. Don’t let your voice bother you when one of the best ENT doctor in Mumbai is right near you!

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