ENT Health

Most so-called 'sinus headaches' are actually migraines — true sinus headaches from sinusitis come with thick coloured nasal discharge, fever, facial tenderness, and worsening when bending forward. Uncomplicated sinusitis after a viral upper respiratory infection usually resolves within 10-14 days with saline nasal rinses, steam inhalation, and decongestants. See a doctor if: symptoms last more than 10 days without improvement or worsen after initial improvement, you have severe facial pain or swelling, vision changes or eye swelling develop (orbital complications), you have high fever with a stiff neck (meningitis risk), or symptoms keep recurring. Antibiotics are appropriate only for bacterial sinusitis — most acute sinusitis is viral and doesn't need them.

Most acute ear infections (otitis media) in children are caused by viruses and resolve without antibiotics in 2-3 days. Current guidelines in most countries recommend a 'watchful waiting' approach for 48-72 hours in children over 2 years with mild symptoms — pain relief with paracetamol or ibuprofen and close observation. Antibiotics are recommended immediately for: children under 6 months, children with severe symptoms (high fever, severe pain), both ears infected in a child under 2, ear discharge (perforated eardrum), or any child who is systemically unwell. If symptoms don't improve in 48-72 hours, then antibiotics are appropriate. Overusing antibiotics for ear infections contributes to resistance without improving outcomes in mild cases.

Obstructive sleep apnea (OSA) occurs when the throat relaxes during sleep and repeatedly blocks the airway — the person stops breathing for 10 seconds or more, dozens or hundreds of times per night. Classic signs: loud snoring with gasping or choking episodes (often noticed by a partner), waking unrefreshed despite adequate sleep, excessive daytime sleepiness (falling asleep during conversations, driving), morning headaches, poor concentration, and irritability. It matters because untreated OSA significantly raises risk of hypertension, heart disease, stroke, type 2 diabetes, and road traffic accidents. Diagnosis requires a sleep study (polysomnography or a home sleep test). Treatment with CPAP — a mask delivering pressurised air to keep the airway open — is highly effective and often transformative for quality of life and cardiovascular risk.

Tonsillectomy is recommended when tonsillitis is genuinely recurrent and disruptive: typically 7 or more episodes in one year, 5 or more per year for two consecutive years, or 3 or more per year for three consecutive years — or when individual episodes cause abscess, febrile convulsions, or missed school or work. It is also indicated for obstructive sleep apnea caused by very large tonsils (especially in children). It is not recommended for mild or infrequent tonsillitis — the tonsils play an immune role in childhood and most children 'grow out' of recurrent tonsillitis by their teens. Discuss the frequency and severity honestly with an ENT surgeon — many tonsillectomies in India are done earlier than evidence supports.

A significant proportion of hearing loss is preventable. Noise-induced hearing loss — from prolonged exposure to loud sound (factory noise, loud music, firecrackers) — is entirely preventable with hearing protection. In India, Diwali firecrackers cause a measurable spike in noise-induced hearing loss each year. Use foam earplugs or earmuffs in noisy environments, keep personal audio at 60% volume maximum, and give your ears rest from noise regularly. Ototoxic medications (certain antibiotics like gentamicin, platinum-based chemotherapy) can cause hearing loss — always inform doctors of hearing status before these are prescribed. Untreated ear infections in children can cause permanent hearing damage — prompt treatment of recurrent infections matters. Age-related hearing loss (presbycusis) is less preventable but can be managed effectively with hearing aids.