Dr James Le Fanu: 5 April
Children are prone to glue ear, the accumulation of a sticky, viscous fluid that reduces the resonance of the eardrum, resulting in impaired hearing and caused by blockage or narrowing of the Eustachian tube that drains the contents of the middle ear to the back of the throat. The logical solution is to make a small hole in the eardrum and insert a grommet, thus improving the ventilation of the middle ear. The grommet is later removed, the eardrum heals and with luck, normal hearing is restored.
There are about 90,000 operations for glue ear in Britain per year, which some doctors suggest are too many, given that it can, in some instances, resolve spontaneously. Still, there is no doubt the improvement in hearing can be dramatic, as an ENT surgeon discovered when he asked parents to enquire from their children how they perceived the effects of the operation.
Their hearing becomes much more acute following insertion of the grommets. Back home, several children reported being startled by the noise of the flush of the lavatory, while a five-year-old child volunteered, ‘I can hear myself peeing again.’
They frequently ask ‘what’s that noise?’ referring to the humming of the refrigerator or birds singing while parental voices sound unnaturally harsh, as in ‘You don’t have to shout at me!’ One boy even cautioned his parents not to discuss him within earshot with the words, ‘Remember, I can hear you now’.
Still, it is possible that some grommet operations would be unnecessary if greater attention was paid to preventing the underlying cause of the blocking of the Eustachian tube. Specialists at London’s Royal National Throat, Nose and Ear Hospital have found that glue ear in some children may be due to the allergic inflammation of the tissues at the back of the nose and throat, known as allergic rhinitis. This is readily treatable with a steroid nasal spray – the inflammation subsides, the Eustachian tube reopens and the child’s hearing improves sufficiently to obviate the need for grommets.
THIS WEEK’S MEDICAL QUERY comes courtesy of a lady from Bristol troubled for the last six months by a very painful frozen shoulder making the simplest of tasks very arduous. She’s had both a steroid injection and physiotherapy but her shoulder remains as stiff and painful as ever. She has, she notes, the general impression that nobody understands the cause. What should she do?
The pain and discomfort of frozen shoulder is due to capsulitis (inflammation of the capsule) around the joint and can indeed be a frustrating condition to treat. The combination of physiotherapy and a steroid injection are standard ‘first line’ treatments but when they do not improve matters there is the further option of ‘manipulation under anaesthesia’.
This involves seeking to restore mobility by forcibly rotating the shoulder to its full range of movement, thus disrupting the fibrous bands in the inflamed capsule that causes it to be ‘frozen’.
drjames@lady.co.uk
There are many different types of poultice that when applied to a boil will bring it to a head – including bacon, bread and hot milk, oatmeal and warm water and baked onion. Jill Nice, author of Herbal Remedies, commends, as an alternative, the technique of cupping with a small-mouthed jar, well rinsed in boiling water.
‘As soon as it is feasible without scalding the patient, the mouth of the jar is placed over the boil until it cools. Suction does the rest and provided the boil is at a stage ready for treatment, the core will come out completely and without unnecessary pain.’
There are about 90,000 operations for glue ear in Britain per year, which some doctors suggest are too many, given that it can, in some instances, resolve spontaneously. Still, there is no doubt the improvement in hearing can be dramatic, as an ENT surgeon discovered when he asked parents to enquire from their children how they perceived the effects of the operation.
Their hearing becomes much more acute following insertion of the grommets. Back home, several children reported being startled by the noise of the flush of the lavatory, while a five-year-old child volunteered, ‘I can hear myself peeing again.’
They frequently ask ‘what’s that noise?’ referring to the humming of the refrigerator or birds singing while parental voices sound unnaturally harsh, as in ‘You don’t have to shout at me!’ One boy even cautioned his parents not to discuss him within earshot with the words, ‘Remember, I can hear you now’.
Still, it is possible that some grommet operations would be unnecessary if greater attention was paid to preventing the underlying cause of the blocking of the Eustachian tube. Specialists at London’s Royal National Throat, Nose and Ear Hospital have found that glue ear in some children may be due to the allergic inflammation of the tissues at the back of the nose and throat, known as allergic rhinitis. This is readily treatable with a steroid nasal spray – the inflammation subsides, the Eustachian tube reopens and the child’s hearing improves sufficiently to obviate the need for grommets.
THIS WEEK’S MEDICAL QUERY comes courtesy of a lady from Bristol troubled for the last six months by a very painful frozen shoulder making the simplest of tasks very arduous. She’s had both a steroid injection and physiotherapy but her shoulder remains as stiff and painful as ever. She has, she notes, the general impression that nobody understands the cause. What should she do?
The pain and discomfort of frozen shoulder is due to capsulitis (inflammation of the capsule) around the joint and can indeed be a frustrating condition to treat. The combination of physiotherapy and a steroid injection are standard ‘first line’ treatments but when they do not improve matters there is the further option of ‘manipulation under anaesthesia’.
This involves seeking to restore mobility by forcibly rotating the shoulder to its full range of movement, thus disrupting the fibrous bands in the inflamed capsule that causes it to be ‘frozen’.
drjames@lady.co.uk
Cup Overfloweth
There are many different types of poultice that when applied to a boil will bring it to a head – including bacon, bread and hot milk, oatmeal and warm water and baked onion. Jill Nice, author of Herbal Remedies, commends, as an alternative, the technique of cupping with a small-mouthed jar, well rinsed in boiling water.‘As soon as it is feasible without scalding the patient, the mouth of the jar is placed over the boil until it cools. Suction does the rest and provided the boil is at a stage ready for treatment, the core will come out completely and without unnecessary pain.’