What is a corn? What is a callus?

Corns and calluses are hard, thickened areas of skin that form as a consequence of rubbing, friction or pressure on the skin.

Corns and calluses form on the feet and can make walking painful.

Although corns and calluses are often talked about together, they are separate conditions.

Corns generally occur on the tops and sides of the toes. A hard corn is a small patch of thickened, dead skin with a small plug of skin in the centre. A soft corn has a much thinner surface, appears whitish and rubbery, and usually occurs between the toes. Seed corns are clusters of tiny corns that can be very tender if they are on a weight-bearing part of the foot. Seed corns tend to occur on the bottom of the feet, and some doctors believe this condition is caused by blocked sweat ducts.

Calluses are hard and rough-feeling areas of skin that can develop on hands, feet or anywhere there is repeated friction – even on a violinist’s chin. Like corns, calluses have several variants. The common callus usually occurs when there has been a lot of rubbing against the hands or feet. A plantar callus is found on the bottom of the foot.

What causes corns and calluses?

Some corns and calluses on the feet develop from an improper walking motion, but most are caused by ill-fitting shoes. High-heeled shoes are the worst offenders. They put pressure on the toes and make women four times as likely as men to have foot problems. Other risk factors for developing a corn or callus include foot deformities and wearing shoes or sandals without socks, which leads to friction on the feet.

Rubbing or pressure can cause either soft corns or plantar calluses. If you or yourchild develops a callus that has no clear source of pressure, have it looked at by a doctor or a podiatrist, since it could be a wart or be caused by a foreign body – such as a splinter – trapped under the skin. Feet spend most of their time in a closed, moist environment, which is ideal for breeding fungal and bacterial infections. Staph (bacterial) infections can start when bacteria enter corns through breaks in the skin and cause the infected skin to discharge fluid or pus.

What are the symptoms of corns and calluses?

• A callus is a patch of compact, dead skin anywhere on the body that is subject to friction. There are different common names given to various types of calluses.
• A hard corn is a compact patch of hard skin with a dense core, located on top of a toe or the outside of the little toe.
• A soft corn is a reddened, tender area of skin, has a thin, smooth centre and is found between toes.
• A seed corn is a plug-like circle of dead skin, often painful, on the heel or ball of the foot.
• A plantar callus is a callus on the bottom – or plantar – surface of the foot.

How do I know if I have a corn or a wart?

To find out whether a hard patch of skin is a corn or a wart, your doctor will examine the affected area. Warts are viral and often have black dots present in the affected skin. They also require specific treatment. Most calluses are corrected by a variety of measures, including a change in shoes, trimming of the calluses and sometimes surgery.

What are the treatments for corns and calluses?

Most corns and calluses gradually disappear when the friction or pressure stops, although your doctor may shave the top of a callus to reduce the thickness. Properly positioned moleskin pads can help relieve pressure on a corn. There are also special corn and callus removal liquids and plasters, usually containingsalicylic acid, but these are not suitable for everyone.

Oral antibiotics generally clear up infected corns, but pus may have to be drained through a small incision.

Moisturising creams may help soften the skin and remove cracked calluses. Apply the moisturising cream to the callus, and cover the area for 30-60 minutes with a plastic bag or a sock – but only if instructed to do so by your doctor or podiatrist.

Then gently rub off as much of the callus as you can with a coarse towel or soft brush. Using a pumice stone first to rub off the dead skin from a callus after a bath or shower and then applying moisturising cream can also be effective.

There are also stronger creams containing urea that might be more effective, but do not use these unless recommended by your doctor or podiatrist. Do not usehydrocortisone creams, which only help with rashes and itching and are not needed for calluses. Moisturising your skin incorrectly can aggravate a fungal condition and should be avoided – especially moisturising between the toes.

You may consider surgery to remove a plantar callus, but there are no guarantees that the callus will not come back. A conservative approach is best initially. Keep your feet dry and friction-free. Wear properly fitted shoes and cotton socks, rather than wool or synthetic fibres that might irritate the skin.

If a podiatrist (a foot specialist) or orthopaedic specialist (a bone and jointspecialist) thinks your corn or callus is caused by abnormal foot structure, your walking motion or hip rotation, orthopaedic shoe inserts or surgery to correct foot deformities may help correct the problem.

How can I prevent corns and calluses?

• To avoid corns and calluses on the feet, always have both feet professionally measured when buying shoes, and only wear properly fitting shoes.
• Make sure that both shoe width and length are correct – for each foot – since your feet may be slightly different sizes. Allow up to 1.3cm (half an inch) between your longest toe and the front of the shoe. If you can’t wiggle your toes in your shoes, they are too tight.
• Avoid shoes with sharply pointed toes and high heels. Women who prefer such shoes, or who are expected to wear them at work, can take some of the pressure off their feet by walking to their destination in well-fitted flat shoes, and then changing them. Try to decrease heel height as much as possible.
• Have your shoes repaired regularly – or replace them. Worn soles give little protection from the shock of walking on hard surfaces, and worn linings can chafe your skin and harbour bacteria.
• Worn heels increase any uneven pressure on your heel bone. If the soles or heels of your shoes tend to wear unevenly, talk to you doctor about corrective shoes or insoles.
• If you have hammertoes – toes that are buckled under – make sure that the shape of your shoes offers plenty of room to accommodate the buckled toes.

An Achilles tendon injury can happen to anyone, whether you’re an athlete or just going about your everyday life.

The Achilles tendon is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles. You can feel it — a springy band of tissue at the back of your ankle and above your heel. It lets you point your toes toward the floor and raise up on your tiptoes.

It’s common for this tendon to get injured. It can be mild or moderate and feel like a burning pain or stiffness in that part of your leg. If the pain is severe, your Achilles tendon may be partly torn or completely ruptured.

Causes

Achilles tendon injuries are common in people who do things where they quickly speed up, slow down, or pivot, such as:

• Running
• Gymnastics
• Dance
• Football
• Baseball
• Softball
• Basketball
• Tennis
• Volleyball

These injuries tend to happen when you start moving suddenly as you push off and lift your foot rather than when you land. For instance, a sprinter might get one at the start of a race as he surges off the starting block. The abrupt action can be too much for the tendon to handle. Men over 30 are particularly prone to Achilles tendon injuries.

These things also can make you more likely to have this kind of injury:

• You wear high heels, which can stress the tendon.
• You have “flat feet,” also called fallen arches. This means that when you take a step, the impact causes the arch of your foot to collapse, stretching the muscles and tendons.
• Your leg muscles or tendons are too tight.
• You take medicines called glucocorticoids or antibiotics called fluoroquinolones.
• 

Symptoms:

The most obvious sign is pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild and get better or worse over time. If the tendon ruptures, the pain is instant and severe. The area may also feel tender, swollen, and stiff.

If your Achilles tendon tears, you may hear a snapping or popping noise when it happens. You could have bruising and swelling, too. You also may have trouble pointing your toes and pushing off your toes when you take a step.

Treatment

Minor to moderate Achilles tendon injuries should heal on their own. To speed the process, you can:

• Rest your leg. Avoid putting weight on your leg as best you can. You may need crutches.
• Ice it. Ice your injury for 20 to 30 minutes every 3 to 4 hours to reduce pain and swelling. Continue this for 2 or 3 days, or until the pain is gone.
• Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling.
• Raise (elevate) your leg. Prop your leg up on a pillow when you’re sitting or lying down.
• Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen will help with pain and swelling. Follow the instructions on the label to help prevent side effects, such as bleeding and ulcers. Take them with food. Check with your doctor first if you have any allergies, medical problems or take any other medication. If you need them for longer than 7 to 10 days, call your doctor.
• Use a heel lift. Your doctor may recommend that you wear an insert in your shoe while you recover. It will help protect your Achilles tendon from further stretching.
• Practice stretching and strengthening exercises as recommended by your doctor, physical therapist, or other health care provider.

 When Will I Feel Better?

It may take months, but it depends on how serious your injury is. Different conditions heal at different rates.

You can still be active while your injury heals. Ask your doctor what’s OK to do. But don’t rush things. Don’t try to return to your old level of physical activity until:

• You can move your leg as easily and freely as your uninjured leg.
• Your leg feels as strong as your uninjured leg.
• You don’t have any pain in your leg when you walk, jog, sprint, or jump.

Can I Prevent an Achilles Tendon Injury?

Here are some things you can try:

• Cut down on uphill running.
• Wear shoes with good support that fit well.
• Stop exercising if you feel pain or tightness in the back of your calf or heel.

A migraine can cause severe throbbing pain or a pulsing sensation, usually on just one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling.

Warning symptoms known as aura may occur before or with the headache. These can include flashes of light, blind spots, or tingling on one side of the face or in your arm or leg.

Medications can help prevent some migraines and make them less painful. Talk to your doctor about different migraine treatment options if you can’t find relief. The right medicines, combined with self-help remedies and lifestyle changes, may help.

Symptoms

Migraines often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages: prodrome, aura, headache and post-drome, though you may not experience all stages.

Prodrome

One or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including:

• Constipation
• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Increased thirst and urination
• Frequent yawning

Aura

Aura may occur before or during migraines. Most people experience migraines without aura.

Auras are symptoms of the nervous system. They are usually visual disturbances, such as flashes of light or wavy, zigzag vision.

Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Your muscles may get weak, or you may feel as though someone is touching you.

Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes. Examples of migraine aura include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking
• Hearing noises or music
• Uncontrollable jerking or other movements

Sometimes, a migraine with aura may be associated with limb weakness (hemiplegic migraine).

Attack

A migraine usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Migraines may be rare, or strike several times a month. During a migraine, you may experience:

• Pain on one side or both sides of your head
• Pain that feels throbbing or pulsing
• Sensitivity to light, sounds, and sometimes smells and touch
• Nausea and vomiting
• Blurred vision
• Lightheadedness, sometimes followed by fainting

Post-drome

The final phase, known as post-drome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated. For about 24 hours, you may also experience:

• Confusion
• Moodiness
• Dizziness
• Weakness
• Sensitivity to light and sound

Causes

Though migraine causes aren’t understood, genetics and environmental factors appear to play a role.

Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.

Imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system — also may be involved. Researchers are still studying the role of serotonin in migraines.

Serotonin levels drop during migraine attacks. This may cause your trigeminal nerve to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is migraine pain. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers

A number of factors may trigger migraines, including:

• Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen.Others have an increased tendency to develop migraines during pregnancy or menopause.Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines. Some women, however, find their migraines occur less often when taking these medications.
• Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
• Food additives. The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines.
• Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people.
• Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
• Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Scheuermann’s disease occurs most often in the upper back, also called the thoracic spine, but occasionally develops in the lower back, or lumbar spine. When the disease is in the lumbar spine, the deformity is usually not as obvious, but the lumbar deformity usually causes greater pain, more limitation on movement, and an increased likelihood of the condition continuing into adulthood.

 

 

 

 

The gradual curves of the human spine allow the body to absorb many shocks and stresses in daily life. It’s a delicate balance, though, and if part of the spine curves too much, pain and limited mobility may result.

Such problems occur at a young age with Scheuermann’s disease, also called Scheuermann’s kyphosis. It can lead to a rounded upper back, sometimes called a hump back, in otherwise healthy adolescents. Scheuermann’s disease is among the most frequent sources of back pain in young people, with pain more likely to follow either exertion or long periods of inactivity.

Symptoms:

Symptoms generally develop between the ages of 10 and 15, a time of considerable growth in the spine. These symptoms are typical:

• Tiredness and muscle stiffness, especially after a day of sitting in class
• Redness on the skin where the curvature is most pronounced and rubs against the back of a chair
• Pain made worse by activities involving twisting, bending, or arching backward, such as when participating in gymnastics, figure skating, dancing, or other sports requiring these types of movements
• Muscle spasms or muscle cramps
• Difficulty exercising
• Back pain or backache, which may come and go
• Limited flexibility
• Tight hamstrings
• Feeling off-balance

Serious damage is rare, but it is possible for Scheuermann’s disease to develop in such a way that the spinal cord or internal organs are harmed. For example, if the lungs become compressed by severe forward posture it can lead to breathing problems.

Treatments :

Treatment for Scheuerman’s disease depends on the individual’s situation. Several factors determining the best treatment include:

• Severity of the curvature in the back
• Amount of flexibility in the area
• Whether the individual is expected to continue to grow
• Concerns about appearance
• Patient preferences

In considering treatments for Scheuermann’s disease, it’s helpful to understand the anatomy of the upper back, or thoracic spine. Human spines are designed to curve, but if the curvature reaches 45 degrees or more, it’s considered abnormal. Allowing an abnormal curvature to continue could cause considerable pain and disfigurement over time.

Observation and Bracing

A young person with a slight curvature who is still growing, shows no sign of the curvature worsening, and has mild or no pain may not require intervention. Instead, the individual could be monitored by a doctor and undergo periodic X-rays, or other tests, to track the curvature. If the curvature worsens, more active treatment would be recommended.

A patient with a more advanced curvature—but with more than a year of growth left—would typically receive more intensive treatment. A back brace would usually be prescribed. Braces can stop or reverse the extra curvature during the growing years by making the front of the vertebrae more upright, which may also reduce pain.

To be most effective, braces should be worn almost all the time, at least at first. Depending on the severity and progression of the curvature, patients may be prescribed a brace for one to two years. Braces can be helpful with curvatures of up to 75 degrees. At one time, braces were thought to be ineffective once spine growth was complete, but recent research indicates there is still a good chance of success after growth has ended.

While braces were once considered bulky and uncomfortable—and often rejected by self-conscious teens—the situation has improved considerably and braces have become less obtrusive and more lightweight. Some of these custom-molded braces can be worn undetected under clothes and allow the young person to take part in activities—including many sports.

Many doctors now recommend these kinds of braces, including the kyphologic and thoracolumbosacral (TSLO)-style Boston braces, over the older, larger Milwaukee brace.

Surgery:

Surgery is rarely needed for Scheuermann’s disease, and nonsurgical options will typically be attempted before surgery is considered.

There are certain situations in which surgery may be advised, however. It may be considered for patients with severe deformities—such as a curvature of more than 75 degrees for thoracic kyphosis, if neurological deficits are present, and occasionally if pain is caused by the deformity.

The goal of the surgery is mainly to reduce the deformity, and possibly lessen pain or neurological symptoms. Surgery will typically include:

• A front thoracotomy (approach through the chest) to release the tissues, remove the discs, and place a bone graft in the spaces to fuse the thoracic spine
• During the same surgery, the spine is then approached from the back and instrumentation, such as rods, bars, wires, or screws, to hold the spine straight during the fusion process is put in place.

After surgery, provided the fusion is successful, all the affected segments will be fused into one continuous bone that will not progress into excessive curvature, or kyphosis. Because Scheuermann’s disease usually occurs in the thoracic spine, which has almost no motion, a fusion in this area does not affect the normal motion of the spine and typically does not lead to pain later in life.

Tailbone Injury Overview

A coccyx injury results in pain and discomfort in the tailbone area (the condition is called coccydynia). These injuries may result in a bruise, dislocation, or fracture (break) of the coccyx. Although they may be slow to heal, the majority of coccyx injuries can be managed with cautious treatment.

The coccyx is the triangular bony structure located at the bottom of the vertebral column. It is composed of three to five bony segments held in place by joints and ligaments.

The majority of coccyx injuries occur in women, because the female pelvis is broader and the coccyx is more exposed.

Tailbone Injury Causes

Most tailbone injuries are caused by trauma to the coccyx area.

• A fall onto the tailbone in the seated position, usually against a hard surface, is the most common cause of coccyx injuries.
• A direct blow to the tailbone, such as those that occur during contact sports, can injure the coccyx.
• The coccyx can be injured or fractured during childbirth.
• Repetitive straining or friction against the coccyx (as happens in bicycling or rowing) can injure the coccyx.
• Sometimes, the cause of coccyx injuries is unknown.
• Less common causes of coccyx injuries include bone spurs, compression of nerve roots, injuries to other parts of the spine, local infections, and tumors.’

Tailbone Injury Symptoms

• Severe localized pain and tenderness may be felt in the tailbone area.
• If the injury is traumatic, a bruise may be visible in this area.
• The pain is generally worse when sitting for prolonged periods of time, or with direct pressure to the tailbone area.
• Bowel movements and straining are often painful.
• Some women may experience pain during sexual intercourse.

Medical Treatment

In addition to home care, a doctor may be able to provide further relief of pain with other medical and, rarely, surgical interventions.

• Stronger pain medicationsmay be prescribed at the discretion of your doctor.
• Stool softeners may be prescribed to prevent constipation.
• Injections of local anesthetics into the tailbone are sometimes required for continuing pain.
• Rarely, the coccyx may be surgically removed.

Follow-up After a Tailbone Injury

Follow-up is recommended at the discretion of your doctor and depends on the severity of the injury and the progress you are making with medical treatment.

• Most people do not require follow-up if their coccyx injury is improving with medical treatment.
• People with chronic tailbone pain, for whom medical therapy has not worked, require more frequent follow-up and may be referred to other medical or surgical specialists.

• Most tailbone injuries are accidental (such as a slip on ice) and therefore cannot be entirely avoided.
• Wear proper protective padding when participating in contact sports that can potentially lead to coccyx injuries.

Cervical lordosis is a curvature of the cervical spine or the vertebrae in the neck region. There is a normal slight curve present in the cervical vertebrae that enables comfortable movement of the neck in a healthy cervical spine. However, when there is a deviation from the normal curve, it can lead to problems. Cervical lordosis is a condition occurring due to excess curvature of the cervical spine, which can lead to pain and discomfort.

The curve in the cervical spine can show great variations and result in varying degrees of complaints. Sometimes, the normal curve straightens out making it difficult to move the neck, sometimes becomes more curved than normal, while sometimes it can be deviated to right or left along with being excessively curved.

Cervical lordosis can be a present during childhood or can occur during the course of life, at any age. Some of the common causes of cervical lordosis include:

• Cervical Lordosis Caused Due to Postural Changes – Poor posture, altered ways of sitting, working at the desk or lifting weight can affect the normal curvature of the cervical spine.
• Cervical Lordosis Caused Due to Congenital Conditions – Certain conditions present since birth may cause excessive lordosis of cervical spine.
• Cervical Lordosis Caused Due to Musculoskeletal Conditions – Other conditions affecting the curvature of the spine, like kyphosis, scoliosis, etc. Weakening of the bones as in osteoporosis. Disorders affecting intervertebral discs like discitis, disc herniation or prolapse. Changes in the position of the vertebrae like spondylolisthesis.

Sometimes, injury or a long standing muscle spasm results in changes in normal curvature, which can lead to either straightening of the spine or excessive lordosis.

Cervical lordosis may be visible as an arch in the cervical spine, noticed as a swayed back neck. It is often noticed that there may be extra space in between the neck and the surface on which you are lying down. Usually people experience discomfort in making neck movements and the range of motion may be restricted.

Pain is often accompanied with difficulty in turning the neck. In some long standing cases, pain may not be felt but the excess curvature can continue to limit regular activities. The muscles around the neck, shoulders and upper back are usually tensed and may be painful to touch. Muscle spasms are commonly noted and may also cause difficulty in moving the neck, raising hands or lifting weights.

If a nerve gets trapped due abnormal curvature of the spine or the tensed muscle, it can also lead to nerve related symptoms. Sometimes, numbness and tingling may be noted in the arms, hands and fingers.

While this condition and muscles spasm often subsides with proper treatment, if left unattended it can progress to cause more difficulty. If there occurs any weakness in the hands and fingers or difficulty in maintaining control, immediate medical attention may be required. Also, changes in the curvature of the spine can lead to further changes in the nearby joints, structures and cause further problems.

Treatment is mainly based on the cause of cervical lordosis, along with symptomatic treatment. Pain medications, muscles relaxants, nerve tonics and nutritional supplements including vitamin D may be given. Depending on the severity of the neck pain and difficulty in neck movements due to cervical lordosis, brace or a neck collar may be advised.

Physical therapy and exercises are often helpful in muscle strengthening, improving range of motion and flexibility. Healthy lifestyle and maintaining ideal body weight is advised to relieve excessive strain on the spine.

In extreme cases of cervical lordosis, surgery may be required.

The spinal cord extends from the base of the brain through the spinal canal to the lower back.

A tethered cord refers to a condition in which the lower spinal cord is restricted (“tethered”) and is not free to develop normally with in the spinal column. This can occur during fetal development or may be associated with build up of scar tissue after previous surgery in or around the spinal cord.

Signs and Symptoms of Tethered Spinal Cord

Signs and symptoms of tethered cord are not specific to this condition, meaning that other disorders may also result in these problems. However, if your child has any of the following, tethered cord should be considered:

• Leg or back pain
• Decrease in strength of legs or feet
• Loss of sensation in the legs
• Deformity of the legs or feet
• Stumbling or walking changes
• Difficulty or delay in toilet training
• Incomplete emptying of the bladder
• Changes in bladder and bowel control
• Curvature of the spine
• Skin abnormalities directly overlying the spinal cord – midline dimples, hairy patches, skin discoloration, skin tags or fatty lumps.

Diagnosis :

 

 

 

 

 

 

Bell’s palsy is a condition in which the muscles on one side of your face become weak or paralyzed. It affects only one side of the face at a time, causing it to droop or become stiff on that side.

It’s caused by some kind of trauma to the seventh cranial nerve. This is also called the “facial nerve.” Bell’s palsy can happen to anyone. But it seems to occur more often in people who have diabetes or are recovering from viral infections.

Most of the time, symptoms are only temporary.

If it happens to you, you may fear you’re having a stroke. You’re probably not. A stroke that affects your facial muscles would cause muscle weakness in other parts of your body, too.

What Causes It?

Most doctors believe that it’s due to damage to the facial nerve, which causes swelling. This nerve passes through a narrow, bony area within the skull. When the nerve swells — even a little bit — it pushes against the skull’s hard surface. This affects how well the nerve works.

Researchers have long believed that viral infections may also play a role in the development of Bell’s palsy. They’ve found evidence that suggests the herpes simplex 1 virus (a common cause of cold sores) may be responsible for a large number of cases.

Symptoms:

The symptoms of Bell’s palsy tend to come on all of a sudden. You may go to bed one night feeling fine. But when you look in the mirror the next morning, you see that part of your face seems to be drooping.

Some people feel pain behind their ear 1-2 days before they notice any weakness. Others say that sounds seem much louder than normal in the days before they see any other symptoms.

• You’re unable to close your eyelid or blink
• Your eye waters more or less than usual
• Drooling
• Difficulty chewing
• Decreased sense of taste
• Your facial muscles twitch
• Pain or numbness behind your ear

Facial weakness and drooping typically reach their peak within a day or two. Most people start to feel better within a couple of weeks. They usually recover completely within 3 months. Some people who develop Bell’s palsy have a longer recovery period. In rare cases, they may have some permanent symptoms.

What Are the Treatments for Bell’s Palsy?

There aren’t any that can stop it. If your doctor suggests your symptoms might be triggered by the herpes virus (herpes simplex 1) or by shingles(herpes zoster), he may give you an antiviral medication, like acyclovir. But there’s no research to show these medications work to reduce Bell’s palsy symptoms.

Your doctor may also give you a short course of corticosteroids (like prednisone). The goal is to decrease swelling of your facial nerve. This may shorten the duration of your Bell’s palsy symptoms.

In the meantime, your doctor will tell you to take extra care to protect your eye on the affected side. He may suggest you wear an eye patch, since you won’t be able to blink. If your eyes are tearing less than normal, you may have to use eye drops to keep them from drying out.

Finally, your doctor may suggest massage of your facial muscles. In very rare cases — where symptoms don’t improve after some time — he may suggest surgery to reduce pressure on your facial nerve.

WHAT IS A PERILYMPH FISTULA?

A perilymph fistula (PLF) is an abnormal connection (a tear or defect) in one or both of the small, thin membranes (the oval window and the round window) that separate the air filled middle ear and the fluid filled perilymphatic space of the inner ear. This small opening allows perilymph (fluid) to leak into the middle ear.

Changes in air pressure that occur in the middle ear (for example, when your ears “pop” in an airplane) normally do not affect your inner ear. However, when a fistula is present, changes in middle ear pressure will directly affect the inner ear, stimulating the balance and/or hearing structures within and causing PLF symptoms.

The perilymphatic space of the inner ear is connected to the cerebrospinal fluid (CSF) that surrounds the brain. Perilymphatic fluid, which is high in sodium (Na+), is similar in composition to CSF. When an abnormal connection between the membranes between the middle and inner ear exists, perilymph in the inner ear escapes, driven by the hydrostatic pressure of the CSF, and is replaced by CSF. This can also result in lower than normal levels of CSF fluid around the brain and spinal cord, which may result in symptoms such as mild headache.

Patients with PLF often feel frustrated and depressed because, while they don’t feel well, they look fine to others. PLF patients specifically and vestibular patients in general often have a challenging time explaining to friends and family what they are going through. Sometimes it is enough to ask your support network for patience and understanding while you explore diagnosis and treatment options and learn to cope with the symptoms brought on by persistent dizziness.

SYMPTOMS :

The symptoms of a PLF most commonly include ear fullness, fluctuating or “sensitive” hearing, dizziness without true vertigo (spinning), and motion intolerance. Vertigo or sudden hearing loss can occur from a PLF. Most people with fistulas find that their symptoms get worse with changes in altitude (fast elevators, airplanes, and travel over moun¬tain passes) or increased CSF pressure resulting from heavy lifting, bending over, and coughing or sneezing.

CAUSES :

Head trauma is the most common cause of fistulas, usually involving a direct blow to the head or in some cases a “whiplash” injury. Other common causes include ear trauma, objects perforating the eardrum, or “ear block” on descent of an airplane or SCUBA diving. Fistulas may also develop after rapid increases in intracranial pressure, such as

may occur with weightlifting or childbirth.

Fistulas are infrequently present from birth. A long-running controversy has surrounded the idea of a “spontaneous PLF.” Instead, what may occur is that a patient has a causative event but does not see an ear specialist right away. The passage of time blurs the memory of such an event so that the PLF might seem to have been spontaneous. Rarely, PLF’s occur in both ears, and only after a severe head injury.

TREATMENT:

When a traumatic event results in sudden onset of hearing loss or dizziness, the patient is advised to severely restrict physical activity for 7-14 days. If the symptoms do not improve or they plateau, testing is ordered. If the tests are compatible with the diagnosis of PLF, a surgical intervention may be considered. Persons with diagnosed fistulas who are awaiting surgery should avoid lifting, straining and bending over as these activities can cause a worsening of the symptoms.

A PLF repair involves an operation, often under general anesthesia, working through the ear canal. The eardrum is lifted up and minute soft tissue grafts are placed around the base of the stapes (stirrup) and in the round window niche. The operation usually takes about 45-60 minutes to complete. There is very little, if any, pain. Some patients are kept overnight to restrict activity. Once discharged the patient is advised to spend three days at home with limited activity. After three days the patient may return to sedentary work activities. The patient is advised to avoid lifting more than 10 lbs. for one month and avoid sporting activities. After one month there are additional restrictions suggested on activities such as contact sports, diving, weight lifting, and roller coasters. All of these activities have resulted in recurrent PLF’s after an initial successful repair.