Cholesteatoma can also cause mastoiditis. This is an abnormal collection of skin cells inside the ear which may prevent the ear draining properly, leading to infection.
Diagnosing mastoiditis
Your GP will examine the inside of the ear with an otoscope (a device with a light and magnifying glass).
If your GP thinks you have mastoiditis as a complication of a middle ear infection, they’ll refer you to an ear, nose and throat (ENT) specialist for further examination and tests.
This usually includes a blood test and an ear culture (where discharge from the ear is tested for a bacterial infection).
Some children may need to have a CT scan, which uses X-rays and a computer to create detailed images of the inside of the skull.
Treating mastoiditis
Mastoiditis is a serious infection and should be diagnosed and treated quickly with antibiotics.
You may need to go to hospital so antibiotics can be given directly into a vein through a drip.
In some cases, surgery may be needed to either:
drain the middle ear (a myringotomy)
remove part of the mastoid bone (mastoidectomy)
If you’re admitted to hospital for treatment you’ll need to stay in for a few days until the ENT specialists can be sure the infection is under control.
After surgery
If you’ve had surgery for mastoiditis, you’ll probably need to take one or two weeks off work.
Take care not to get the affected ear wet. You should be able to wash your hair after about a week, providing you don’t get water inside your ear.
You should be able to go swimming around four to six weeks after the operation, depending on how well your ear has healed.
Your doctor should be able to give you specific advice after surgery and at any follow-up appointments.
Complications of mastoiditis
Although most people with mastoiditis don’t experience serious complications, treatment isn’t always easy and the infection may come back.
If the mastoid bone is severely infected and isn’t removed, it can cause hearing loss and life-threatening health complications such as:
Noonan syndrome can affect a person in many different ways. Not everyone with the condition will share the same characteristics.The 3 most common characteristics of Noonan syndrome are:
People with Noonan syndrome may have a characteristic facial appearance, although this isn’t always the case.
The following features may become apparent soon after birth:
a broad forehead
drooping eyelids (ptosis)
a wider-than-usual distance between the eyes
a short, broad nose
low-set ears that are rotated towards the back of the head
a small jaw
a short neck with excess skin folds
a lower-than-usual hairline at the back of the head and neck
Children with Noonan syndrome also have abnormalities that affect the bones of the chest. For example, their chest may stick out or sink in, or they may have an usually wide chest with a large distance between the nipples.
These features may be more obvious in early childhood, but tend to become much less noticeable in adulthood.
Short stature
Children with Noonan syndrome are usually a normal length at birth. However, at around 2 years old you may notice that they don’t grow as quickly as other children of the same age.
Puberty (when a child begins to mature physically and sexually) typically occurs a few years later than normal, and the expected growth spurt that usually happens during puberty is either reduced or doesn’t happen at all.
Medication known as human growth hormone can sometimes help children reach a more normal height. Left untreated, the average adult height for men with Noonan syndrome is 162.5cm (5ft 3in) and for women is 153cm (5ft).
Heart defects
Most children with Noonan syndrome will have some form of congenital heart disease. This is usually one of the following:
pulmonary valve stenosis – where the pulmonary valve (the valve that helps control the flow of blood from the heart to the lungs) is unusually narrow, which means the heart has to work much harder to pump blood into the lungs
hypertrophic cardiomyopathy – where the muscles of the heart are much larger than they should be, which can place a strain on the heart
septal defects – a hole between 2 of the chambers of the heart (a “hole in the heart”), which can cause the heart to enlarge and/or lead to high pressure in the lungs
Other less common characteristics of Noonan syndrome can include:
learning disability – children with Noonan syndrome tend to have a slightly lower-than-average IQ and a small number have learning disabilities, although these are often mild
feeding problems – babies with Noonan syndrome may have problems sucking and chewing, and may vomit soon after eating
behavioural problems – some children with Noonan syndrome may be fussy eaters, behave immaturely compared to children of a similar age, have problems with attention and have difficulty recognising or describing their or other people’s emotions
increased bruising or bleeding – sometimes the blood doesn’t clot properly, which can make children with Noonan syndrome more vulnerable to bruising and heavy bleeding from cuts or medical procedures
eye conditions – including a squint (where the eyes point in different directions), a lazy eye (where one eye is less able to focus) and/or astigmatism (slightly blurred vision caused by the front of the eye being an irregular shape)
hypotonia – decreased muscle tone, which can mean it takes your child a bit longer to reach early developmental milestones
undescended testicles – in boys with Noonan syndrome, one or both testicles may fail to drop into the scrotum (sac of skin that holds the testicles)
infertility – particularly if undescended testicles aren’t corrected at an early age, there’s a risk of boys with Noonan syndrome having reduced fertility; fertility in girls is usually unaffected
lymphoedema – a build-up of fluid in the lymphatic system (a network of vessels and glands distributed throughout the body)
bone marrow problems – a small number of people can develop an abnormal white blood cell count; this can sometimes get better on its own, but can occasionally turn into leukaemia
A variety of different tumours (cancerous growths) have also been found in people with Noonan syndrome, but it’s often not clear if these are caused by the condition or occur by chance.
Overall, the risk of developing cancer doesn’t appear to be much higher than for people without Noonan syndrome, although there may be a very small increased risk of some rare childhood cancers.
Page last reviewed: 21/06/2018
Next review due: 21/06/2021
Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). If it keeps happening, it’s called gastro-oesophageal reflux disease (GORD).
Check if you have acid reflux
The main symptoms of acid reflux are:
heartburn – a burning sensation in the middle of your chest
an unpleasant sour taste in your mouth, caused by stomach acid
You may also have:
a cough or hiccups that keep coming back
a hoarse voice
bad breath
bloating and feeling sick
Your symptoms will probably be worse after eating, when lying down and when bending over.
Causes of heartburn and acid reflux
Lots of people get heartburn from time to time. There’s often no obvious reason why.
Sometimes it’s caused or made worse by:
certain food and drink – such as coffee, alcohol, chocolate, and fatty or spicy foods
being overweight
smoking
pregnancy
stress and anxiety
some medicines, such as anti-inflammatory painkillers (like ibuprofen)
a hiatus hernia – when part of your stomach moves up into your chest
How you can ease heartburn and acid reflux yourself
Simple lifestyle changes can help stop or reduce heartburn.
Do
eat smaller, more frequent meals
raise one end of your bed 10 to 20cm by putting something under your bed or mattress – make it so your chest and head are above the level of your waist, so stomach acid doesn’t travel up towards your throat
try to lose weight if you’re overweight
try to find ways to relax
Don’t
do not have food or drink that triggers your symptoms
do not eat within 3 or 4 hours before bed
do not wear clothes that are tight around your waist
do not smoke
do not drink too much alcohol
do not stop taking any prescribed medicine without speaking to a doctor first
A pharmacist can help with heartburn and acid reflux
Speak to a pharmacist for advice if you keep getting heartburn.
They can recommend medicines called antacids that can help ease your symptoms.
It’s best to take these with food or soon after eating, as this is when you’re most likely to get heartburn. They may also work for longer if taken with food.
Ehlers-Danlos syndromes (EDS) are a group of inherited conditions that affect connective tissue.Connective tissues provide support in skin, tendons, ligaments, blood vessels, internal organs and bones.
There are several types of EDS that may share some symptoms, including:
The different types of EDS are caused by faults in certain genes that make connective tissue weaker. Depending on the type of EDS, the faulty gene may have been inherited from one parent, or both parents.
Sometimes the faulty gene isn’t inherited, but occurs in the person for the first time.
EDS can affect people in different ways. For some, the condition is relatively mild, while for others their symptoms can be disabling. Some of the rare severe types can be life-threatening.
Main types of EDS
Hypermobile EDS is the most common type of EDS. Rarer types include classical EDS, vascular EDS and kyphoscoliotic EDS.
Hypermobile EDS
Hypermobile EDS (hEDS) is often thought to be the same as or very similar to another condition called joint hypermobility syndrome.
Currently, there are no tests to confirm whether someone has hEDS. The diagnosis is made based on a person’s medical history and a physical examination.
Classical EDS
Classical EDS (cEDS) is less common than hypermobile EDS and tends to affect the skin more.
People with cEDS may have:
joint hypermobility
loose, unstable joints that dislocate easily
stretchy skin
fragile skin that can split easily – especially over the forehead, knees, shins and elbows
Vascular EDS (vEDS) is a rare type of EDS and is often considered to be the most serious. It affects the blood vessels and internal organs, which can cause them to split open and lead to life-threatening bleeding.
People with vEDS may have:
skin that bruises very easily
thin skin with visible small blood vessels, particularly on the upper chest and legs
fragile blood vessels that can bulge or tear, resulting in serious internal bleeding
a risk of organ problems, such as the bowel tearing, the womb tearing (in late pregnancy) and partial collapse of the lung
hypermobile fingers and toes, unusual facial features, (such as a thin nose and lips, large eyes and small earlobes), varicose veins and delayed wound healing
Kyphoscoliotic EDS
Kyphoscoliotic EDS (kEDS) is rare.
People with kEDS may have:
curvature of the spine – this starts in early childhood and often gets worse in the teenage years
joint hypermobility
loose, unstable joints that dislocate easily
weak muscle tone from childhood (hypotonia) – this may cause a delay in sitting and walking, or difficulty walking if symptoms get worse
fragile eyes that can easily be damaged
soft, velvety skin that is stretchy, bruises easily and scars
Getting medical advice
See your GP if you have several troublesome symptoms of EDS.
You don’t usually need to worry if you only have a few symptoms and they’re not causing any problems. Joint hypermobility, for example, is common in healthy people and is unlikely to be caused by EDS if you don’t have any other symptoms.
Your GP may refer you to a joint specialist (rheumatologist) if you have problems with your joints and they suspect EDS. If there’s a possibility you may have one of the rare types of EDS, your GP can refer you to your local genetics service for an assessment.
The local genetics specialist will ask about your medical history, family history, assess your symptoms and may carry out a genetic blood test to confirm the diagnosis.
If further investigation is needed, your hospital doctor can refer you to a specialist EDS diagnostic service based in Sheffield and London.
Living with EDS
There’s no specific treatment for EDS, but with support and advice it’s possible to manage many of the symptoms.
Adapting your activities
It’s important to be careful about activities that put a lot of strain on your joints or put you at risk of injury. However, it’s also important not to be overprotective and avoid living an otherwise normal life.
Advice will depend on which type of EDS you have and how it affects you.
you may be advised to avoid some activities entirely, such as heavy lifting and contact sports
for some activities, you may need to wear appropriate protection and be taught how to reduce the strain on your joints
lower-risk activities, such as swimming or pilates, may be recommended to help you stay fit and healthy
if fatigue is a problem, you can be taught ways to conserve your energy and pace your activities
For more tips and advice on joint care, you can read about living with EDS on the Ehlers-Danlos Support UK website.
Specialist support
People with EDS may also benefit from support from a number of different healthcare professionals. For example:
a physiotherapist can teach you exercises to help strengthen your joints, avoid injuries and manage pain
an occupational therapist can help you manage daily activities and give advice on equipment that may help you
for certain types of EDS, regular scans carried out in hospital can detect problems with internal organs
genetic counselling can help you learn more about the cause of your condition, how it’s inherited, and what the risks are of passing it on to your children (see below)
Your GP or consultant can refer you to these services.
How EDS is inherited
EDS can be inherited, but in some cases it occurs by chance in someone without a family history of the condition.
A person with EDS can only pass on the same type of EDS to their children. For example, the children of someone with hypermobile EDS can’t inherit vascular EDS.
The severity of the condition can vary within the same family.
Floaters are small shapes that some people see floating in their field of vision.
They can be different shapes and sizes and may look like:
tiny black dots
small, shadowy dots
larger cloud-like spots
long, narrow strands
You may have many small floaters in your field of vision or just one or two larger ones. Most floaters are small and quickly move out of your field of vision.
Floaters are often most noticeable when you’re looking at a light-coloured background, such as a white wall or clear sky.
Do floaters affect vision?
Floaters sometimes occur without a person noticing them. This is because the brain constantly adapts to changes in vision and learns to ignore floaters so they don’t affect vision.
Floaters are usually harmless and don’t significantly affect your vision. However, it’s important you have your eyes checked by an optician regularly (at least once every two years).
Larger floaters can be distracting and may make activities involving high levels of concentration, such as reading or driving, difficult.
Floaters are small pieces of debris that float in the eye’s vitreous humour. Vitreous humour is a clear, jelly-like substance that fills the space in the middle of the eyeball.
The debris casts shadows on to the retina (the light-sensitive tissue lining the back of the eye). If you have floaters, it’s these shadows you’ll see.
Floaters can occur as your eyes change with age. In most cases, they don’t cause significant problems and don’t require treatment.
In rare cases, floaters may be a sign of a retinal tear or retinal detachment (where the retina starts to pull away from the blood vessels that supply it with oxygen and nutrients).
Floaters can’t be prevented because they’re part of the natural ageing process.
When to seek medical help
Visit your optician immediately if you notice an increase or sudden change in your floaters, particularly if you notice white flashes and some loss of vision.
Your optician may refer you to an ophthalmologist (a specialist in diagnosing and treating eye conditions) who can check your retina for tears or retinal detachment.
Even though floaters are usually harmless and don’t significantly affect your vision, it’s important you have your eyes checked regularly by an optician (at least once every two years).
In most cases, floaters don’t cause major problems and don’t require treatment. Eye drops or similar types of medication won’t make floaters disappear.
After a while, your brain learns to ignore floaters and you may not notice them.
If your floaters don’t improve over time, or if they significantly affect your vision, a vitrectomy may be recommended. This is a surgical operation to remove the vitreous humour in your eye along with any floating debris and replace it with a saline (salty) solution.
If your retina has become detached, surgery is the only way to re-attach it. Without surgery, a total loss of vision is almost certain. In 90% of cases, only one operation is needed to re-attach the retina.
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