Ear Nose and Throat

Nose Bleed Facts

Have you ever had nose bleeding? Or had a friend or relative with nose bleeding and you did not know what to do? Well, this blog is meant to teach you some facts about nose bleeds as well as first aid maneuvers when you encounter one.

The nasal cavity has numerous blood vessels which are located close to the surface lining. These vessels are fragile and prone to bleed easily.

The most common causes of nose bleeds are a breakdown in the lining in the nose, trauma to the nose or face, high altitude, drug abuse involving the nose, high blood pressure, anti-clotting medications, and medical conditions that prevent your blood from clotting.

Nose bleeds are usually benign in origin, but may cause the patients or their relatives to worry. It is important that you should not panic.

The following first aid maneuvers, are usually enough to control the bleeding:

  1. Sit up straight and lean slightly forward. A common misconception is that tilting your head back will make the bleeding stop. The reality is, tilting your head back will only cause you to swallow blood which can irritate your stomach and make you vomit afterwards.
  2. Pinch your nostrils together, applying direct pressure with the thumb and index/ middle finger for approximately 10 minutes.

  3. Spit out any blood in the mouth. As I said before, swallowing blood may make you vomit.

  4. Put an ice pack over the nose bridge (NOT over the forehead). Chewing on ice chips may help in some cases.

Treatment of the underlying cause of nosebleed such as control of hypertension is important. If the nosebleed persists 10 minutes, it is best to proceed to the emergency room for further management.

If the nosebleed is recurrent, it is recommended that you see your ENT specialist, who may do a nasal endoscopy to rule out any nasal tumors that may be causing the bleeding.

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Have You Seen a Hole in Front of Your Ear?

ENT Manila, Philippines - pre-auricular sinusThis is a common congenital anomaly called a PRE-AURICULAR SINUS.

You see, when you were just a fetus in your mother’s wombs, you looked like a tadpole. And the external ear or the pinna, looked like gills.

These “gills” are called the Hillocks of His which are seen at around the 6th week of gestation. These Hillocks then fuse together to become our external ear.

An incomplete fusion of these Hillocks results in any ear deformity, including a PRE-AURICULAR SINUS.

Pre-auricular sinuses are frequently seen on routine physical examination by an ENT in Philippines as small holes in front of the external ear.

These holes are openings into a narrow tube or duct which connects into the perichondrium (or the thin cover) of the ear cartilage.

Most people with pre-auricular sinuses are asymptomatic. Only one third of persons are aware of their malformations.

However, some patients may have pus or foul-smelling discharge from the small opening. These draining sinuses are prone to become infected.

Infections of these pre-auricular sinuses present with swelling of the area anterior to the ear and ulcerations. Often, these ulcerations are treated with antibiotics and the pre-auricular sinus, which is the source of the infection, is neglected. When the infections are recurrent, the area becomes scarred and deformed.

[This is a picture of a 10 year old I operated on for a chronically infected pre-auricular sinus.]

Once a patient has infection of the sinus, antibiotics must be started. Other laboratory studies such as culture of the abscess may be done to make sure the pathogens are covered for by the given drugs.

Surgical removal of the sinus tract is advised once infection occurs because the risk of repeated infections is high.

Surgery involves COMPLETELY removing the opening and tracing the duct to the infected pouch, removing even part of the ear cartilage is advocated. Incomplete excision results in recurrence as high as 43 % in some studies.

It is important therefore, that you should consult a skilled head and neck surgeon for removal of your pre-auricular sinus.


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Q-tipSee the image on the left? Yup, the ever famous q tip! This little thing is used by thousands, even millions worldwide to clean their ears everyday.

But, did you know that using Q-tips in your ears can actually do you more harm than good?

Take a look at our skin. Everyday it gets dry, cells are being replaced by new skin cells everyday , we take a bath everyday just to keep our skin clean.

We also have similar skin lining our ear canal.

So, the question is do you have to clean your ears everyday , as you do to the rest of your skin? The answer is NO. you do not “NEED” to clean your ears. And the reason is EARWAX. ear diagram

A lot of people view earwax as just dirt in the ear canal. The fact is earwax helps protect your sensitive ear canal by trapping dirt, sand, insects and other foreign substances.

Earwax is the ear’s moisturizer, it helps prevent excessive dryness in the ear canal and on the outer ear. 

It also repels water.

And, it acts as an antibacterial agent- it helps prevent infection.

Think about it, we already have this built-in self-cleaning, moisturizing, anti-bacterial mechanism in our ears, and yet everyday, we strip our ears of it.

ear canal diagramWhat is worse, is that by using q-tips, if you are not removing the earwax, you are actually pushing it in, into an area, where it is not able to clean itself. Unlike skin in the rest of the body which is replaced in an upward direction., meaning old cells slowly go up where they eventually end in the top layer and easily removed by friction, the skin in the ear canal goes out by MIGRATION: meaning skin goes from the center of the ear drum, to the edge of the eardrum and then goes out slowly to the ear canal. This skin as well as other debris is mixed with the oil and secretions from glands in the outer 1/3 of the ear canal is what forms the earwax.

When you push the earwax in and it builds up inside the canal, it may be more prone to accumulate fungus, bacteria which may cause ear infections

This can also block your hearing and cause deafness, or it may eve n rupture your eardrum

Another reason why you should not clean your ears is because unlike the skin in the rest of the body which is 5 layers thick, the skin in the inner 2/3 of the ear canal is very very thin and is surrounded by bone. By cleaning your ears with q-tips you may be creating micro-abrasions, as well as releasing histamine which causes itchiness. As a reflex of course, when something is itchy, you scratch it again. By doing that, you are actually creating a viscious “scratch-and-itch” cycle. And that pattern has to stop.

It is best to see your ENT doctor so you can have your ears cleaned by a medical professional.eustachian tube ear diagram

In summary, the earwax is the ear’s self cleaning mechanism. It is a water repellant, a moisturizer, and an anti bacterial agent. And this is what happens when you use q-tips to clean your ears:

1. You make our ear canals dry

2. You push the earwax in

3. You may block your hearing,

4. You may rupture your eardrum,

5. You may cause ear infections, and,

6. You create viscious “scratch-and-itch” cycle in your ear.


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A patient came into the emergency room complaining that he could not swallow. This is his back story:

He was 21 years old and had 2 missing front teeth. Of course, he wanted to look good and wanted to get dentures. The problem was he lacked funds. Upon the advice of a friend, he went to a “technician” who allegedly sold cheap dentures. Everything was all right until one day, he fell asleep and ACCIDENTALLY SWALLOWED his dentures.

At the emergency room, laboratory work up and imaging studies were done. He was then rushed to the operating room for emergency esophagoscopy (an operation where a tube is passed via your mouth to visualize the esophagus or the swallowing tube). During the operation however, there was difficulty in removing the dentures because the sharp and jagged edges were buried so deep into the mucosa (inner lining) of the esophagus. A skin incision was subsequently made anterior to the sternocleidomastoid muscle in the neck to make a lateral pharyngotomy approach (making an incision on the muscles to the side of the esophagus) to removing the dentures stuck into his neck.

MORAL LESSON:Philippines ent

  1. Always remove your dentures before sleeping.

  2. Never sacrifice the quality of your dentures for the price. It may end up costing you more.


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