Aarogya ENT Centre

30/07/2025

प्लेनमा कान डुम्म भयो वा कान दुख्यो भने के गर्ने ? Aarogya ENT Center “👂👃👅 “आरोग्य ई.एन. टी. सेन्टरबुटवल - ८०७१-५३५०२५ / ९७४५४१६९५५डा. सुमन पौडेल —— नाक, कान, घॉटी, थायरोइड, एलर्जी तथा टाउको र घॉटी क्यान्सर रोग बिशेषज्ञ"👂👃👅 Visit Aarogya ENT Center Butwal for expert care! Our dedicated team provides comprehensive ear, nose, and throat services. Your health is our priority! 🏥"Contact us for booking an appointment : 9745416955, 071535025

29/07/2025

New Advances in ENT, Head and Neck Surgery

The integration of the 3D View Vision head-mounted display with the ORBEYE exoscope improved ergonomics, visualization, and surgeon comfort during head and neck microsurgery. https://ja.ma/45r46cg

29/07/2025

Avoid Prescribing Betahistine and Cinnarizine Together – A Common but Serious Error seen in many prescriptions.

We must understand the pharmacological contradiction between two widely used anti-vertigo drugs: Betahistine (Betaserc) and Cinnarizine.
Yet, it’s becoming increasingly common to see both medications written together in the same prescription — and this is a major clinical error.

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⚠️ Why is this combination wrong?

Betahistine acts as a vestibular enhancer. It stimulates histamine H1 receptors and promotes central compensation — the brain's natural adaptation to vestibular dysfunction. It's used for long-term management in conditions like Ménière’s disease

Cinnarizine, on the other hand, is a vestibular suppressant. It blocks H1 receptors and calcium channels, reducing input from the inner ear to relieve acute vertigo — but it also suppresses central compensation if used for more than a few days.

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❌ When prescribed together:

You are sending mixed signals to the vestibular system — stimulating and suppressing it at the same time. This not only reduces clinical effectiveness, but may also delay recovery and confuse patients, who feel no real benefit from either drug.

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✅ Proper use:

Use Cinnarizine or other vestibular suppressants only during the acute phase (2–5 days).

Then discontinue suppressants and switch to Betahistine or start vestibular rehabilitation to support neuroplastic recovery.

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📚 Evidence-Based Support:

Strupp & Brandt (2009) – Vestibular suppressants hinder central compensation if used long-term.

Baloh (2003) – Suppressants may relieve symptoms but delay recovery.

European Ménière’s Disease Guidelines (2015) – Recommend Betahistine; discourage prolonged use of suppressants.

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🗣️ Final message:

> Do not write both Betaserc and Cinnarizine in the same prescription.
Understand the mechanism, indication, and timing of each — and help your patient recover, not stagnate.

29/07/2025

🗣️ Does your child struggle to speak clearly?
🎓 Our expert Speech Therapists help children and adults develop confident communication skills through personalized therapy.

✅ Child Speech Therapy
✅ Adult Voice Therapy
✅ Swallowing Therapy
✅ Auditory Verbal Therapy

📍 Visit us at Aarogya ENT Center Sundarchowk, Butwal-8 (Bhatbhateniline).

📞 Call us now: 071-535025 / 9745416955 or message us to book an appointment!

26/07/2025

Clinical Lessons Learned – Case of Suspected Congenital Cholesteatoma in an 11-Year-Old Girl

1️⃣ Recurrent ear discharge is not always simple chronic otitis media

When a child presents with intermittent ear discharge that temporarily responds to medical treatment, clinicians should not be falsely reassured.

Recurrent symptoms despite treatment suggest an underlying pathology such as cholesteatoma, rather than just external or middle ear infection.

2️⃣ Keratin debris in the anterosuperior quadrant is a red flag

The presence of white debris or keratin seen behind an intact tympanic membrane, particularly in the anterosuperior quadrant, is highly suggestive of congenital cholesteatoma.

This region is a typical site for congenital lesions due to embryological epithelial remnants.

3️⃣ Congenital cholesteatoma can present without obvious perforation

Unlike acquired cholesteatoma, congenital cases often occur behind an intact drum, making early diagnosis easy to miss unless carefully examined under a microscope.

4️⃣ Imaging is essential in uncertain or suspicious cases

High-resolution CT of the temporal bone should be requested in any child with persistent otorrhea, keratin debris, or suspected middle ear mass.

CT helps in assessing ossicular integrity, extent of lesion, and surgical planning.

5️⃣ Early diagnosis prevents irreversible damage

Delayed diagnosis can lead to ossicular erosion, hearing loss, or even facial nerve involvement and labyrinthine fistula.

Early surgical removal often results in better hearing preservation and fewer complications.

6️⃣ Don't underestimate “dry” ears with subtle findings

Even in the absence of active discharge or hearing loss, a pearly white mass behind the drum should always raise suspicion.

Silent congenital cholesteatoma can remain unnoticed for years before complications appear.

25/07/2025

Snoring isn’t just annoying — it could be your body’s way of warning you.
A blocked airway or sleep apnea can lead to interrupted breathing, poor sleep, fatigue, and even increase your risk of heart problems.

If snoring is a regular part of your night, it’s time to take it seriously.
Get evaluated by our ENT specialists at Aarogya ENT Center and sleep better, breathe better.

📍Visit us:
आरोग्य ई.एन. टी. सेन्टर
सुन्दरचोक, भाटभटेनी लाईन,
सुख्खानगर, बुटवल - ८

📞Book Your Appointment: 071-535025 / 9745416955

23/07/2025

चक्कर लाग्ने रोग र उपचार ।

Clinical Case – Metronidazole-Induced Dizziness (With Polypharmacy Insight)

👩‍⚕️ A female patient in her early 30s, obese, with type 2 diabetes, presented with sudden onset of severe dizziness and headache.
Neurological and vestibular examination were unremarkable, and brain MRI showed no abnormalities.

🧪 Blood glucose levels were within normal range at the time of symptoms. There were no signs of diabetic complications or orthostatic hypotension.

🦷 She had been suffering from a dental infection with a draining abscess. Following multiple consultations with general practitioners and dentists, she received several overlapping prescriptions — all of which included metronidazole. The patient ended up taking more than 6 tablets daily for several consecutive days.

🟢 Notably, her symptoms began to improve after stopping metronidazole.

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🧠 Clinical Interpretation:

This presentation is highly suggestive of metronidazole-induced central dizziness, despite the absence of MRI abnormalities. While classic metronidazole neurotoxicity can show T2/FLAIR hyperintensities in areas like the dentate nuclei, such radiologic findings are not mandatory for diagnosis. The strong temporal relationship, in addition to symptom improvement post-discontinuation, supports the diagnosis.

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📌 Personal Clinical Insight – Polypharmacy as an Overlooked Cause:

> In my clinical experience, one of the most underestimated causes of dizziness is polypharmacy — even when the drugs involved are intended to treat dizziness itself.

This case reinforces how patients — especially those with chronic conditions like diabetes — often see multiple providers, accumulating redundant or interacting medications.

I’ve encountered multiple cases where withdrawal of unnecessary drugs (including antivertigo medications, sedatives, or antibiotics like metronidazole) led to dramatic improvement in balance and clarity.

🧠 Medication review should always be a core part of dizziness assessment.

22/07/2025

🩺 छाला सुई परीक्षण (Skin Prick Test) – एलर्जी पत्ता लगाउने भरपर्दो उपाय! 🌿

के तपाईंलाई पटक–पटक नाक बग्ने, हाच्छिउँ आउने, छालामा र्‍यास आउने, वा आँखा पोल्ने समस्या छ?
यी लक्षणहरू एलर्जीका कारण हुन सक्छन्।

✅ अब समाधान छ – Skin Prick Test!
यो परीक्षणले तपाईं कुन–कुन चिजमा एलर्जी छ भनेर 20-30 मिनेटमै पत्ता लगाउँछ।

📌 परीक्षणद्वारा थाहा पाइने एलर्जीहरू:
• धुलो/धुलो जस्तै धुलो पर्नेलाई
• परागकण (Pollen)
• जनावरको रौँ
• खानामा प्रयोग हुने वस्तुहरू
• औषधिजन्य एलर्जी

🕒 छिटो, सुरक्षित र प्रभावकारी परीक्षण
👨‍⚕️ विशेषज्ञ डाक्टरको निगरानीमा गरिन्छ

📍 परीक्षण उपलब्ध:
[आरोग्य हेल्थ केयर, सुन्दरचोक, भाटभटेनी लाइन, बुटवल–८]
📞 सम्पर्क: 9745416955 / 071535025

अब एलर्जीको कारण मात्र होइन, समाधान पनि थाहा पाउनुहोस्।
📆 आजै समय लिनुहोस्!

15/07/2025

Dix-Hallpike Manoeuvre
This manoeuvre is critical for diagnosing Benign Paroxysmal Positional Vertigo (BPPV) and differentiating peripheral from central positional vertigo. This test should be conducted when the patient complains of vertigo provoked by specific head–neck movements or in certain head positions. Typical symptoms are brief intense spells of rotatory vertigo which usually precipitates during an abrupt change in head position, getting out of bed, turning over in bed, bending over, looking up or when extending or flexing the neck.

Aarogya ENT Center “👂👃👅 “
आरोग्य ई.एन. टी. सेन्टर
बुटवल - ८
०७१-५३५०२५ / ९७४५४१६९५५

डा. सुमन पौडेल —— नाक, कान, घॉटी, थायरोइड, एलर्जी तथा टाउको र घॉटी क्यान्सर रोग बिशेषज्ञ

"👂👃👅 Visit Aarogya ENT Center Butwal for expert care! Our dedicated team provides comprehensive ear, nose, and throat services. Your health is our priority! 🏥"

Contact us for booking an appointment : 9745416955, 071535025

11/07/2025

01/07/2025

🎤 Protect Your Voice – Vocal Hygiene Tips!
👩‍⚕️ From the experts at Aarogya ENT Center, Sukkhanagar, Butwal-8
📞 Contact: 9745416955 | 071-535025

🗣️ Your voice matters – take care of it! Here are some simple tips to maintain healthy vocal cords:

✅ Stay Hydrated – Drink at least 8–10 glasses of water daily.
✅ Avoid Throat Clearing – Try swallowing instead.
✅ Limit Caffeine & Alcohol – They dry out your throat.
✅ Don’t Shout or Whisper – Use a natural, relaxed voice.
✅ Rest Your Voice – Especially if you're sick or strained.
✅ Use a Humidifier – Especially in dry weather.
✅ Avoid Smoking & Irritants – They can damage your vocal cords.
✅ Warm Up Before Speaking – Especially for teachers, singers, speakers.
✅ Seek Help Early – Persistent hoarseness needs ENT attention!

👨‍⚕️ Consult Dr. Suman Paudel & our team of ENT specialists for personalized care.

🩺 Aarogya ENT Center – Your trusted partner for ear, nose, throat & voice health.
📍 Location: Sukkhanagar, Butwal-8
📞 9745416955 | 071-535025