Otolaryngologist

Also known as otorhinolaryngolongists or ENT specialists, otolaryngolongists are doctors who specialize in diagnosing and treating disorders of the ear, nose and throat. After completing medical school, a one year residency in general surgery is compulsory further followed by four years of residency in otolaryngology. Being specialists in the ENT organs, otolaryngolongists perform the following functions:

• Primarily treat disorders related to ear, nose, and throat.
  
• Treat conditions like sinus and problems with nasal cavities by either prescribing medicines or performing surgery.
  
• They treat allergies and help improve the shape and look of the nose (rhinoplasty).
  
• They treat hearing problems, ear infections, balance disorders of the ears, tinnitus (ear noise), cranial nerve disorder etc.
  
• They treat conditions like sleep apnea.
  
• They cure tonsils either through medication or surgery, they treat throat disorders including voice and swallowing disorders.

Modern techniques used in the field of otolaryngology

ENT field has seen a lot of innovations in use of equipment and technology, modern methods have paved avenues for better treatment methods.

• Modern equipment have paved ways for these specialists to perform reconstructive surgeries for nose, jaw, ear and facial areas.
  
• RAST (radio-allergosorbent-test) is used for curing allergies.
  
• Technique called the skin endpoint titration is used to cure allergies.
  
• Endoscope technique is used to treat sinus and other blockages.
  
• Modern audio logic equipment is used to diagnose and treat hearing problems.

Guide to choose the right otolaryngologist

• Ask your family physician to refer to the right specialist.
  
• Check if the specialist you have chosen is certified by an authorized board.
  
• Check if the hospital where your specialist practices has the required infrastructure and modern equipment needed for your treatment.
  

Otoplasty

Cosmetic surgery to alter the looks of the external ears is referred to as otoplasty. Otoplasty can move, remove, add, or reshape the ear as per the individual’s choice. ENT surgeons, plastic surgeons or maxillofacial surgeons carry out this procedure. This procedure will cost about US$ 2,000 to US$ 5,000. Otoplasty is usually done when the person is aged between 4 and 14 though this surgery can be performed on adults too. This surgery produces very good results in children rather than adults as their cartilage are not as firm as adult cartilage. Through otoplasty you can:

• Bring the ears closer to the head; popularly known as ear pinning.
  
• Reshape any bend in the ear cartilage.
  
• Reduce the size of the ears if they are very big.
  
• Correct deformed ears or absent-microtic ears.
  

Otoplasty is performed under local anesthesia combined with sedation or under general anesthesia if the surgery involves kids. Anesthesia is chosen depending on the severity of the case. Otoplasty is usually performed as an outpatient procedure and takes about two to three hours to get completed. The person can get back to normalcy after five to seven days. The ear should not be bent for about a month and the person should wear a bandage to protect the ears for about a week.

Different types of otoplasty procedures

Incision less otoplasty: Needle is positioned via the skin to sculpt the cartilage and to hold the retention sutures. One incision is made to sculpt the ear; this incision is made behind the ear. The necessary correction is carried out through this incision.

Ear reduction otoplasty: reducing the components in the ear, incisions made are not visible.

Microtia: small ear deformity can be corrected by adding components as per requirement. Reconstruction procedure is usually performed on the cartilage of the ear.

Anotia: Missing ear deformity can be corrected by adding components as per requirement. Reconstruction procedure is usually performed on the cartilage of the ear.

Risks of otoplasty

• Blood clots in the ear, it either dissolves on its own or can be removed by the surgeon.
  
• Infection in the cartilage, this can be treated with antibiotics.
  
• Numbness of the skin in the ear or the face.
  
• Pain for a long duration.
  
• Permanent scarring.
  
• External ear canal might narrow down.
  

Misophonia

Just few years back, in 2010, Misophonia was recognized as an emerging rare disorder. It continues to be so. Till date, Misophonia is a relatively unknown disorder. Misophonia is a disorder related to hearing particular sounds. Psychologists call these individuals as Misophones. Their relationship with sounds isn't normal. Hearing particular sounds send Misophones into an unbearable frenzy.

Misophonia Unclassified

Research on Misophonia is limited. The classification is still discussed. Studies are conducted by neurosurgeons, cognitive neurologists, clinical psychologists, neuro psychiatrists and animal psychics. Is Misophonia a Neurological, Psychiatric, or Auditory Disorder? There is an ongoing debate whether Misophonia can be classified as its own psychological disorder or it is just a symptom of underlying psychiatric disorder such as Obsessive Compulsive Disorder or generalized anxiety.

Misophonia is mostly regarded as a neurological disorder and is termed as selective sound sensitivity syndrome (4S) - a condition in which a person reacts extremely negatively to certain sounds that don't bother most people.

Upsetting, Annoying, Enraging Sounds



Literal meaning of Misophonia is 'hatred to sounds'. 'Miso' means dislike or hatred, 'phonia' means sounds. The sounds are everyday sounds. Nothing exceptional. The sounds can be loud or soft ones. Hearing these sounds make individuals with Misophonia angry, irritated, anxious, agitated, – all negative responses. From feeling moderate discomfort, the sounds can set in an intense panic and full-fledged rage.

• Awful tickling noise
  
• Tapping feet on floor
  
• Annoying chomping noise
  
• Sound of nails on a chalkboard
  
• Rumbling of a snoring person
  
• Crunching on snacks
  
• Clinking of silverware
  
• Rubbing of chalk against the blackboard
  
• Sound of heavy breathing
  
• Shifting of a table
  
• Candy wrapper crushing
  
• Throat clearing
  
• Slurping on soups
  
• Excited squeals
  
• Leg fidgeting
  
• Clocks tickling
  
• Teeth brushing
  
• Snapping fingers
  
• Clicking keys in computer
  
• Pen clicking
  
• Car alarms
  
• Chewing
  
• Coughing
  
• Scratching
  
• Typing

Reasons for behavior

There are 4000 plus Misophones who post on web forums. Misophonia behavior is still being researched. In all probability, people with Misophonia could have unusually strong neural connections between sound-processing parts of their brains and their limbic systems (emotional systems) which regulate emotion. Simply put, it is due to criss-crossing of wires - the wires that affect hearing get crossed with wires that affect emotions.

Also, there seems to exist a connection with psychiatric conditions like anxiety, depression and obsessive-compulsive disorder. People with Misophonia develop a negative reaction to annoying sounds and gradually it becomes a natural behavior/reaction/response to these sounds.

Onset of Misophonia

Research conducted so far indicates that the symptoms often appear in late childhood, pre-teen or just before puberty and worsen with time. In some cases, Misophonia triggers are noticed in early childhood. If not attended to Misophonia persists entire lifetime. Initially the aversion is limited to a specific sound which later can include more sounds.

Reaction to specific sounds

Misophones respond differently to the sounds they hate. Mild feeling or severe response, the reaction could be any one of these. This is referred to as Misophonia Activation Scale.

• Aware of sounds that annoy them. Have not had any negative experience with those annoying sounds.
  
• Experience discomfort. Able to withstand the trigger and strive to move away from the annoying sound, divert self or if possible withstand the situation and related sound.
  
• Experience significant negative response. If a polite request to stop the annoying sound is turned down, he/she strives to escape the trigger event as it is difficult to endure it.
  
• Experience at least one fight or flight response.
  
• Experience a powerful fight or flight response. Feel the trigger event is a deliberate attempt to mock, irritate and insult the individual with Misophonia.
  
• Enthused to 'sarcastically' mimic the annoying sound or exhibit anger at the person making the sound. There is an urge to scream. Some people experience physiological reactions.
  
• Highly unbearable to hear specific sounds, there is a high possibility of verbal assault. If the offending sound doesn't stop, the Misophones exhibit physical discontent.
  
• The hatred of specific sounds is intense. Frantic effort to stop the sound. Express apathy of people in understanding the pain of individuals with Misophonia.
  
• More of a physical response phase, there is marked violent behavior towards self or others. Ready to inflict pain on self or others to relieve their pain.

Treating Misophonia

There is no official treatment sanctioned by the American Psychiatric Association. The search for a specific cure is on. There are many potential coping strategies. Effectiveness of these isn't yet proved but has provided the much needed relief. Many have benefited from these. At least, the symptoms are reduced. Before opting for any of the coping strategies, check with a consultant on Misophonia – audiological physician or an ENT surgeon.

Tinnitus retraining therapy (TRT): TRT teaches people with Misophonia how to improve their ability to tolerate the specific annoying noises. The combination of sound therapy and teaching/demystification/learning about mechanisms helps in remaining unprovoked.

Cognitive behavioral therapy: Initial sessions aim at deciphering the specific sounds, individual's thoughts and feelings associated with the sound. Subsequently, people with Misophonia are taught ways to improve thoughts thereby finding relief and feeling better.

Neurofeedback: Here is an expensive therapy that doesn't work for everyone and is not covered by most health insurance plan. Neurofeedback therapists or practitioners are trained to administer neurofeedback therapy. The session lasts 30 minutes. The therapy involves recording the waves of electrical activity emitted by the brain when EEG or Electroencephalography is administered. Electronic sensors attached to the ears and scalp read the brain waves when music and light/images are shown. The feedback is recorded and analyzed. The aim is to help the brain self-regulate or self-correct. Neuro feedback benefits the brain and body like improved sleep, heightened mental clarity and enhanced cognitive performances.

Sound therapy: Clinics that provide sound therapy play background noises to counteract trigger sound. The individual is conditioned to respond in a particular manner. The approach is to decondition the individual's response. Combined with psychological counseling, Sound therapy has proved effective for some individuals with Misophonia.

Clinical hypnosis: The focus is to help relax when the sound troubles the mind.

Check basics: Paying attention to the basics can help. A healthy and balanced diet combined with consistent and adequate exercise help manage stress thereby reducing the intensity of triggers.

Other options

• Ear plugs and sound masks to block out intriguing and annoying sounds.
  
• Music to distract from trigger and reduce reactions.
  
• Talk therapy and anti-depressants prescribed by health care provider.
  
• A stress ball to squeeze when feeling overwhelmed.
  
• Get plenty of sleep, regular exercise and manage stress.
  
• Create a room at home with sounds you enjoy to mask triggers.
  
• Let people around you know of Misophonia to gain support.
  
• Find support from Misophonia Association.
  
• Interact online where people share Misophonia coping strategies.