Hoarse voice
sound is produced in the voice box. For this the voice box has 2 tiny bands with a core of thin muscles covered with a slim smooth lining. Vibration of these structures produces sound.
When these structures get injured, hoarseness results.
1. The primary nature of injury is overuse of voice as would occur after
A.  talking for long periods of time as is common in teachers.
B. Talking very loudly or shouting even if it is for a short period of time as when one looses one's temper and screams.
This commonly results in vocal nodules or firm clots at points of maximum vibration and sometimes vocal cord bleeds
2. Smoking, tobacco use and excessive alcohol intake are also known to injure the lining and result in cancers and more serious disorders.

Many people suffer from pain in the ears during flights. Using cotton in the ear to prevent this is useless. The fundamental cause is that the ear drum has air behind it which is derived from a tiny tube which connects it to the nose, eustachian tube. This tube opens only when we swallow - the muscles of the palate which move during swallowing tug on this tube to open it. Cabin pressure changes during ascent & descent of flight need to be compensated by swallowing repeatedly to open this tube. For those who are prone to this problem,  two pieces of advice,

1. Use nose drops like otrivin/nasivion half an hour before the flight to keep the tube open.

2. Chew a bar of chocolate which induces you to swallow repeatedly during ascent & descent of flight.

Resistant cases may require ventilation tube insertions.

How should we clean the ear wax?
Most people have self cleansing ears with  no tendency to wax accumulation. They could do without bothering about the ear.
For others, it would be a good idea to do 2 things
1. Once in a week or in a fortnight, use oil to soften the formed wax and aid spontaneous migration. This could be any clean oil with no sediment. Refined Coconut oil is often used. Strictly avoid  putting any sediment like garlic pieces which is a common traditional practice.
2. Avoid using ear buds. Buds can be used only very superficially and that too after coating the bud with an antisceptic ointment which will lubricate the dry bud. Ear buds can often push the wax inside and impact  or jam it inside.

Wax once impacted needs to be cleaned by a qualified ENT Specialist who would disimpact it and syringe it with warm water.

2 special notes of caution:
1. AVOID Using Hydrogen peroxide in the ear. This is a common practise especially among quacks. The bubbles and froth it produces gives a "false" impression of the wax being cleaned. It can perforate through a thin ear-drum.
2. AVOID splashing water in the ear in an attempt to clean the wax. Nature is producing it's own oil. Trust it. Ear remaining wet can often promote fungus growth in the ear.

Ear wax is formed in everybody's ear.
The skin of which lines the passage leading to the ear-drum  is multilayered (as is the skin all over the body).  It is constantly being rejuvinated from within. The deeper layers are the newly formed young cells which push the"oldies" cells outwards which ultimately flake out and fall. Elsewhere in the body the fallen flakes are washed off.
But the ear passage being a closed tube (like a test -tube ) the dead flakes have to be specially taken care of - else they would accumulate and jam up the passage.
Nature produces a special oil called "sebum" which mixes in the dead flakes and the action of the jaw movement during the act of chewing causes the soft kneaded wax to "migrate" outwards . (Check it out for yourself - keep a finger in the ear and move your jaw by opening & shutting the mouth and feel the ear canal move).
So a small quantity of wax is being formed everyday which goes Unnoticed.
The problem of wax accumulation occurs due to:
1. Natural causes which could be
a. Less sebum or oil being produced which causes the formed wax to harden and become less capable of migrating outwards.
b. A naturally excessive curved passage leading to the drum casing a bump over which the wax cannot migrate easily.
2. Man made causes. Frequent use of ear buds especially pushing them deep in the ear in an attempt to clean the deep wax can often result in the migrating wax being pushed inside resulting in impaction


.

If you constantly feel the need to itch your ear, the 2 main causes are :
1. Repeated fungal infections.
Fungal debris unless cleaned meticulously from the lining skin    tends to regrow. Only a qualified ENT Specialist can do this .
One must thereafter prevent water getting into the ear.
Dry ear-buds when used can injure the skin and cause it to bleed or weep causing a wet environment which induces fungus growth.
2. Neuro dermatitis or thinning of the lining skin. The most common cause of this again is constant use of ear buds. The buds being dry often cause a minor shave-off of the delicate skin lining.
Use of dry ear- buds therefore can be damaging to the ear and be the cause of ear itching.
Hence one must coat the ear-buds with an antiseptic ointment before use.

2 Main reasons:
1. Fungus in the ear. Fungus grows in areas of dampness. Water caught In the ear during a swim or head shower Is not uncommon. Forceful  ear-bud use can scrape the delicate ear skin to "weep" a thin fluid.
Fungus once formed has to be cleaned thoroughly. Antifungal drops like "Candid ear drops" help prevent recurrence
2- Dermatitis or infection -and thinning of the delicate skin of the ear canal Is also a common cause. Again ear-bud use is a common root cause. Buds must be used with a coating of a Lubricating antiseptic cream like "Eclospan cream".

The ear drum is known to perforate. The ability for a perforation to heal spontaneously depends on various factors.
l. The size of the perforation: small ones especially those caused by acute colds and due to injuries like slaps or eat buds, usually have a good chance of self healing. If the size is within 25'/. of the size of the ear drum, the perforation almost invariably heals.
2. Their duration: If detected within 6 weeks, the chances of spontaneous closure are maximum.
3.when the discharge stops, only then nature's healing process starts
4. The treating doctor's skill, honesty and will to try and avoid an operation.     

Have you ever seen your nose in the mirror? 2 reddish blobs, one on each side. See them through the day, the size keeps changing. Did you know that they are one of the most sophisticated gates that nature has provided you with? At these gates are sensors which are analysing each & every breath for its content especially dust, humidity & temperature. If the air is dust filled, the gates appear swollen - but for a good cause. The air turbulence ensures a finer cleaning of the inhaled air. Viruses, bacteria & allergens play havoc at these gates & cause you to wish that you never had a nose. It's our job to mend these gates, surgery is not the only answer. Medical gatekeeping is an art.

Deviated nasal septum is not a disease. The nasal septum is only a partition in the nose, it is almost never straight. Unnoticed injury to the nose in early childhood when learning to maintain balance is the most common cause of this injury. Air can take a curved passage with ease, the cause of nose block therefore lies in dysfunction of structures within the nose other than the septum; nasal turbinates being the most common. If surgery has been suggested for this, it's time u take a second opinion.