Nose

d) Hearing Loss

Hearing loss is the inability to hear sounds that everyone normally hears. Although hearing impairment and hearing loss are used interchangeably, the truth is that the former refers to the difficulty of hearing but not to the impossibility. Age is the most common cause of progressive hearing loss. From the age of 65 onward, about half of all people have some degree of hearing impairment, and this number increases with age. The main consequences of hearing loss and hearing impairment are to social and work relationships, which can lead to anxiety and depression. In addition, there is a relationship between hearing loss and accidental falls. Although hearing difficulty occurs in the elderly, steps can be taken to avoid it or slow it down. There are professions that expose people to developing hearing loss, including construction, carpentry, nightclub clerks, and MRI technicians. The relationship between aircrew members and hearing loss has also been studied both because of the noise and because of the continuous pressure changes to which they are exposed.

Prevention

• Avoid continuous exposure to loud noise. • If working in a noisy environment, try to use safety headphones. • See a hearing specialist if you have symptoms of difficulty hearing so that the level of hearing can be determined and a device can be recommended to improve it.

Nose

a) Nosebleeds

Nosebleeds have many causes. It is common to see this in very dry climates, whether they are hot or cold, because the nasal mucosa gets dry and is very sensitive to changes in humidity. It can also be due to a traumatic event or changes in blood pressure. In the ER, I have seen patients come in with heavy nosebleeds. Many people recommend putting your head back; in fact, you see it a lot on TV and movies. But this is not a good recommendation. The blood that comes out of the nose comes from the front of the mucosa; by putting the head back, we swallow it, which can cause stomach upset. It is ideal to lean forward and squeeze your nostrils for about ten seconds while you breathe through your mouth. The fingers are placed a little higher than the nostrils, without hurting the septum. TenarAiuola, Own work, CC BY-SA 3.0

Putting ice on the top of your nose, between the eyes, is also good advice. I never recommend inserting paper or cotton into the nostrils. If something is introduced, I would choose to use gauze since it does not leave any remains inside the orifices.

b) Foreign Body in the Nose

The nose and ears are places where foreign bodies can commonly get stuck. In children and patients with dementia, this is more likely to occur; however, we must be vigilant as it is a situation that can occur at any time to anyone. If a foreign body is left in one of these holes and time passes, an infection could develop that may bring other complications. Objects stuck in the nose are sometimes visible and can even be picked out with fingers or tweezers. The procedure to remove it must be done with outward movements, otherwise the object will be introduced further and may get stuck in the back of the nose, where it is not possible to remove it without specialized assistance. If the object is visible inside the nose, you can try to remove it by covering the opposite side and asking the person to blow hard until it comes out. This procedure should be repeated until the foreign body comes out. This option is very useful and one I recommend the most since it does not damage the mucosa and it is impossible for the object to get stuck in the back of the nose. In the event that the object is badly stuck and does not come out by the above methods, a homemade device for extraction can be tried. The original instrument used by ENT doctors is a surgical hook that you can build with a paper clip or with a wire that is not very rigid. In the picture to the right, you can see what the hook remover looks like. You’re going to make a paper clip that has the same effect as the original instrument. This instrument is gently inserted through the nostril where the foreign body is located and is then attached to the paper clip. All the movements must be very smooth and always trying to pull out. Remember that this mucosa is fragile and can bleed, but a little bit of blood is not something to worry about. Once the foreign body is out, it should be checked for completeness. A spray such as Afrin, which contains a substance that constricts blood vessels and prevents bleeding, can be applied to the nostril.

Sarindam7, Own work, CC BY-SA 4.0