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When there is abnormal growth of the bone of the middle ear, otosclerosis is said to occur. This disease of ear bone degeneration is usually noticed during early adult years. The bones of the ear turn into spongy bone tissue and lead to excessive buildup of bone tissue. This impairs the hearing process since there is a barrier to sound being conducted to the inner ear. The bones are then unable to vibrate and pass the sound into the inner ear. Usually the outer and middle ear are affected, leading to conductive hearing loss. Nerves of the ears may also get affected, leading to senso-neural hearing loss. Otosclerosis is noticed to occur in persons with family history of hearing loss. Hearing may be impaired in one or both ears. This condition affects nearly 10% of the American population. Pregnancy is known to trigger this condition in some women.

One of the most common symptoms of otosclerosis is tinnitus (noise originating inside the ear). Hearing loss may be gradual, which is why this condition is not often diagnosed at the early stage. Other accompanying symptoms are dizziness and balance problems. In many cases, persons suffering from otosclerosis are not even aware of their condition and do not seek medical help. An otologist (ear physician) will need to conduct a physical examination and study the history of hearing loss This condition can be diagnosed with the help of audiometric examination and special x-rays. A CT scan of the temporal bone can help in ruling out other causes of hearing loss. The hearing and balance functions will be assessed with various tests and procedures. Audiometry, tympanometry and tuning fork tests are conducted to test the extent of hearing loss.

A hearing aid is used to treat this condition when the hearing loss is mild. You can take the help of an audiologist to choose the one that fits your specific needs best. Doses of oral sodium fluoride are known to improve otosclerosis. Sodium fluoride aids calcification of new bone and checks further otoscelerotic damage. Fluoride medication along with calcium and Vitamin D are prescribed. A surgical procedure known as stapedectomy is performed to replace the fixed stapes bone in the ear with a prosthesis. This device allows sounds waves to pass to the inner ear. The stapes bone is either completely or partially removed. The laser stapedectomy surgery is usually performed under local anaesthesia and is an outpatient procedure. Only one year is operated at a time. In most of the cases, stapedectomy benefits the patient suffering from otosclerosis. After surgery, a patient must avoid loud noises and sudden changes in pressure for a few weeks. Rarely are there complications with this surgery leading to total deafness or formation of blood clots in the ear.

Lentigo Maligna

Melanoma, a type of skin cancer is categorized into four types, three are 'in situ' and the fourth type is invasive. In situ is a very early stage of melanoma and does not invade enough to be considered invasive. Lentigo Maligna is 'in situ'. The cancer cells are in the top layer of the skin (epidermis) and are contained in the area in which the cells started to develop. If left untreated, 'in situ' lentigo maligna can become invasive.

  • Lentigo maligna is more common in males.
  • Working outdoors (exposure to UV rays) increases risk.
  • Early childhood exposure to sunburn blisters increases chance of developing at later stage of life.
  • Family history increases chance of developing lentigo maligna.
  • Begins as a patch.
  • Occurs around hair follicles on the sun-damaged skin of the head and neck or even face.
  • Grows very slowly over many years.
  • Diagnosed usually during middle age and the elderly.

Lentigo Maligna - ABCD rule

Initially, it appears as a mole in the sun exposed areas. Over time, it grows into an odd-looking, multi-colored structure that doesn't go away. The ABCD rule is useful to recognize lentigo maligna. Considering these as lentigo maligna symptoms, without any delay, it is best to seek medical attention.

A: Stands for asymmetry. The mole can be anywhere on the skin which is not symmetric in shape.

B: Stands for border. The border of the mole is ragged, notched, and irregular.

C: Stands for color. The mole is multi-colored, a mixture of brown, black, red, blue or white in varying shades and patterns.

D: Stands for diameter. The size of the mole is more than 6mm.

Lentigo maligna diagnosis

Post a visual examination of the affected areas, a skin biopsy is recommended by the doctor. A biopsy is required for diagnosis. The biopsy involves removing the growth and a small part of the surrounding skin to analyze it under a microscope. Confirming lentigo maligna diagnosis, the doctor determines the best course of treatment.

Lentigo maligna treatment

Early detection and medical attention restrains the lesions or mole from spreading across the skin's surface. If left untreated, it can spread deeper into the skin and can eventually pass to other parts of the body.

Slow Mohs is a preferred surgical technique for completely removing the melanoma. Along with it, about 5mm margin of normal tissue is also excised. Radiation or cryosurgery is resorted to when the lesion is difficult to access and excise. Under local anaesthesia, surgery is performed. Healthy tissues around the area are also removed as a precautionary step leaving no cancerous cells. If the mole or lesion is in an area where spare skin is not available, like the face or lower leg, skin graft to remove the lesions may be required. A plastic surgeon would remove skin and replace it from another area. A follow-up visit may or may not be required.

Lentigo maligna self care tips

Lentigo maligna is not hereditary but it is more likely to develop when a close relative has suffered a melanoma. Self care tips can prevent getting another lentigo maligna.

  • Monthly self examination of the whole body applying ABCD lentigo maligna rule.
  • Protect your skin from too much exposure to the sun. Use sun-care tips like sun protection cream, wearing a hat, cotton clothes, avoiding sun bathing, sunburn and tanning etc.
  • Avoid sun beds and tanning lamps.
  • Avoiding direct sunlight exposure can be substituted to an extent with Vitamin D supplements.
  • Inform family members particularly the youngsters keeping in mind the genetic influence.

Spinal Anesthesia

Spinal anesthesia is administered through injection to anaesthetize or numb the lower part of the body before performing surgery on the patient. Spinal anesthesia is a type of regional anesthesia and will block the pain below the site of the injection. This kind of anesthesia is injected into the spine of the lower back through a long needle. The medicine is directly administered into the fluids surrounding the spine. This is normally given between L3 - L4. Unlike general anesthesia, here the patient is awake and conscious during the procedure.

Surgeries performed under spinal anesthesia

Spinal anesthesia suits simple surgical procedures involving short duration. It is a single shot and hence medicine is given only once and no catheter is placed for further medication. Once the medicine is administered, spinal anesthesia starts working instantly. As soon as the shot is given, patient will begin to experience a hot feeling in the lower part of the body and subsequently the area becomes numb. Spinal anesthesia is appropriate for the surgeries performed below the umbilicus like:

  • Vaginal repair or vaginal hysterectomies
  • Hernia operation
  • Piles
  • Varicose veins
  • Orthopaedic surgeries on the legs, pelvis
  • Prostate removal
  • Operation on genitals
  • Surgery for trauma on lower limbs

Spinal anesthesia procedure

Firstly, patient will be positioned appropriately. The patient will be made to sit on the edge of the operating table keeping the stool under the legs for support or the patient will be made to lie down on one side, knees tucked up to the chest. Once positioned, the lower back will be cleaned with antiseptic lotion. Small dose of local anesthesia will be given at the site where the spinal will be administered so that patient does not feel the piercing pain. The anesthetist administers the spinal injection and will remain in the operation theatre throughout to check the progress and the effect of anesthesia.

Spinal anesthesia complications

Spinal anesthesia is less risky when compared to general anesthesia. Patient can return to normalcy in no time and also there are less chances of developing chest and lung infections and other respiratory disorders. However, spinal anesthesia may give rise to few side effects like:

  • Headache
  • Itching on the body
  • Low blood pressure

These conditions are quite manageable and treatable and will wane off within few hours after the procedure. Neurological injury is an extremely rare complication that may be caused by spinal anaesthesia.

Tags: #Otosclerosis #Lentigo Maligna #Spinal Anesthesia
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Collection of Pages - Last revised Date: February 28, 2024