Ruptured eardrum (perforated eardrum)
Overview
A ruptured eardrum — or tympanic membrane perforation as it's medically known — is a hole or tear in the thin tissue that separates your ear canal from your middle ear (eardrum).

A ruptured eardrum can result in hearing loss. A ruptured eardrum can also make your middle ear vulnerable to infections or injury.

A ruptured eardrum usually heals within a few weeks without treatment. Sometimes, however, a ruptured eardrum requires a procedure or surgical repair to heal.

Symptoms
Signs and symptoms of a ruptured eardrum may include:

Ear pain that may subside quickly
Clear, pus-filled or bloody drainage from your ear
Hearing loss
Ringing in your ear (tinnitus)
Spinning sensation (vertigo)
Nausea or vomiting that can result from vertigo
When to see a doctor
Call your doctor if you experience any of the signs or symptoms of a ruptured eardrum or pain or discomfort in your ears. Your middle and inner ears are composed of delicate mechanisms that are sensitive to injury or disease. Prompt and appropriate treatment is important to preserve your hearing.

Causes
Causes of a ruptured, or the perforated, eardrum may include:

Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluids in your middle ear. Pressure from these fluids can cause the eardrum to rupture.
Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.

Other events that can cause sudden changes in pressure — and possibly a ruptured eardrum — include scuba diving and a direct blow to the ear, such as the impact of an automobile airbag.

Loud sounds or blasts (acoustic trauma). A loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave — can cause a tear in your eardrum.
Foreign objects in your ear. Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.
Severe head trauma. Severe injury, such as skull fracture, may cause the dislocation or damage to middle and inner ear structures, including your eardrum.
Complications
Your eardrum (tympanic membrane) has two primary roles:

Hearing. When sound waves strike it, your eardrum vibrates — the first step by which structures of your middle and inner ears translate sound waves into nerve impulses.
Protection. Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria and other foreign substances.
If your eardrum ruptures, complications can occur while your eardrum is healing or if it fails to heal. Possible complications include:

Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the tear can affect the degree of hearing loss.
Middle ear infection (otitis media). A perforated eardrum can allow bacteria to enter your ear. If a perforated eardrum doesn't heal or isn't repaired, you may be vulnerable to ongoing (chronic) infections that can cause permanent hearing loss.
Middle ear cyst (cholesteatoma). A cholesteatoma is a cyst in your middle ear composed of skin cells and other debris.

Ear canal debris normally travels to your outer ear with the help of ear-protecting earwax. If your eardrum is ruptured, the skin debris can pass into your middle ear and form a cyst.

A cholesteatoma provides a friendly environment for bacteria and contains proteins that can damage the bones of your middle ear.

Prevention
Follow these tips to avoid a ruptured or perforated eardrum:

Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection, including earache, fever, nasal congestion and reduced hearing. Children with middle ear infection often rub or pull on their ears. Seek prompt evaluation from your primary care doctor to prevent potential damage to the eardrum.
Protect your ears during flight. If possible, don't fly if you have a cold or an active allergy that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum. Or use the Valsalva maneuver — gently blowing, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Don't sleep during ascents and descents.
Keep your ears free of foreign objects. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. These items can easily tear or puncture your eardrum. Teach your children about the damage that can be done by putting foreign objects in their ears.
Guard against excessive noise. Protect your ears from unnecessary damage by wearing protective earplugs or earmuffs in your workplace or during recreational activities if a loud noise is present.

Runny nose

WHAT IS A RUNNY NOSE?

A runny nose is never any fun, especially when it comes with a cold or allergies. It can interrupt your daily life, making you reach for the tissue box every few minutes. But what is a runny nose exactly? A runny nose is a nasal discharge of mucus. Your doctor might use the term “rhinorrhea” to diagnose the runny nose


Causes of the runny nose include:

Acute sinusitis (sinus infection)
Allergies
Chronic sinusitis
Churg-Strauss syndrome
Common cold
Decongestant nasal spray overuse
Deviated septum
Drug addiction (substance use disorder)
Dry air
Granulomatosis with polyangiitis (Wegener's)
Hormonal changes
Influenza (flu)
Lodged object
Medications
Nasal polyps
Nonallergic rhinitis (chronic congestion or sneezing not related to allergies)
Occupational asthma
Pregnancy
Respiratory syncytial virus (RSV)
Spinal fluid leak
Tobacco smoke

HOW CAN TREAT A RUNNY NOSE?

The good news is a runny nose will usually clear up on its own. Until then, there are simple steps you can take to relieve your symptoms:

Get plenty of rest: When you’re not feeling well, it’s crucial to get plenty of sleep so your body can heal. Plus, resting will give you a much-needed break from blowing your nose!

Drink more fluids: Sipping lots of water and clear chicken broth will help thin your mucus and allow it to drain faster from your nose and sinuses. Drinking hot tea or milk can also have a soothing, warming effect.

Use a saline nasal spray or drops: Using a gentle saline nasal spray or drops three to four times a day can help stop a runny nose and make it easier to breathe. The saline solution will help soothe the mucous membranes inside the nose.

Take an over-the-counter medication: Non-prescription medications can help ease your symptoms. Although Vicks products won’t cure a runny nose, they can help you feel better. NyQuil SEVERE helps dry up your nasal passages to relieve your runny nose.

Overview
Rubella, also called German measles or three-day measles, is a contagious viral infection best known by its distinctive red rash.

Rubella is not the same as measles (rubeola), though the two illnesses do share some characteristics, including the red rash. However, rubella is caused by a different virus than measles and is neither as infectious nor usually as severe as measles.

Symptoms
The signs and symptoms of rubella are often so mild they're difficult to notice, especially in children. If signs and symptoms do occur, they generally appear between two and three weeks after exposure to the virus. They typically last about one to five days and may include:

Mild fever of 102 F (38.9 C) or lower
Headache
Stuffy or runny nose
Inflamed, red eyes
Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
A fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and legs, before disappearing in the same sequence
Aching joints, especially in young women
When to see a doctor
Contact your doctor if you think you or your child may have been exposed to rubella or if you have the signs or symptoms listed above.

If you're contemplating getting pregnant, check your vaccination record to make sure you've received your MMR inoculations. If you're pregnant and you contract rubella, especially during your first trimester, the virus can cause death or serious birth defects in the developing fetus. Rubella during pregnancy is the most common cause of congenital deafness. It's best to be protected against rubella before pregnancy.

If you're pregnant, you'll likely undergo routine screening for immunity to rubella. But if you've never received the vaccine and you think you might have been exposed to rubella, contact your doctor immediately. A blood test might confirm that you're already immune.

Causes
The cause of rubella is a virus that's passed from person to person. It can spread when an infected person coughs or sneezes, or it can spread by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from pregnant women to their unborn children via the bloodstream.

A person with rubella is contagious for one to two weeks before the onset of the rash until about one or two weeks after the rash disappears. An infected person can spread the illness before the person realizes he or she has it.

Rubella is rare in the United States because most children receive a vaccination against the infection at an early age. However, cases of rubella do occur, mostly in unvaccinated foreign-born adults.

The disease is still common in many parts of the world. The prevalence of rubella in other countries is something to consider before going abroad, especially if you're pregnant.

Complications
Rubella is a mild infection. Once you've had the disease, you're usually permanently immune. Some women with rubella experience arthritis in the fingers, wrists, and knees, which generally lasts for about one month. In rare cases, rubella can cause an ear infection (otitis media) or inflammation of the brain (encephalitis).

However, if you're pregnant when you contract rubella, the consequences for your unborn child may be severe, and in some cases, fatal. Up to 80 percent of infants born to mothers who had rubella during the first 12 weeks of pregnancy develop congenital rubella syndrome. This syndrome can cause one or more problems, including:

Growth retardation
Cataracts
Deafness
Congenital heart defects
Defects in other organs
Intellectual disabilities
The highest risk to the fetus is during the first trimester, but exposure later in pregnancy also is dangerous.

Prevention
The rubella vaccine is usually given as a combined measles-mumps-rubella inoculation, which contains the safest and most effective form of each vaccine. Doctors recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school. It's particularly important that girls receive the vaccine to prevent rubella during future pregnancies.

Usually, babies are protected from rubella for six to eight months after birth because of the immunity passed on from their mothers. If a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.

Do you need the MMR vaccine?
You don't need a vaccine if you:

Had two doses of the MMR vaccine after 12 months of age
Have blood tests that indicate you're immune to measles, mumps and rubella
Are a man who was born before 1957
Are a woman who was born before 1957, you already had the rubella vaccine, or you have a positive rubella immunity test
You typically should get a vaccine if you don't fit the criteria listed above and you:

Are a nonpregnant woman of childbearing age
Attend college, trade school or a postsecondary school
Work in a hospital, medical facility, childcare center or school
Plan to travel overseas or take a cruise
The vaccine is not recommended for:

Pregnant women or women who plan to get pregnant within the next four weeks
People who have had a life-threatening allergic reaction to gelatin, the antibiotic neomycin or a previous dose of MMR vaccine
If you have cancer, a blood disorder or another disease, or you take medication that affects your immune system, talk to your doctor before getting an MMR vaccine.

Side effects of the vaccine
Most people experience no side effects from the vaccine. About 15 percent of people develop a fever between seven and 12 days after the vaccination, and about 5 percent of people develop a mild rash. Some teens and adult women experience temporary joint pain or stiffness after receiving the vaccine. Fewer than 1 out of 1 million doses cause a serious allergic reaction.

In recent years, as the number of children diagnosed with autism has risen — without a clear explanation — widespread concerns have been raised about a possible link between the MMR vaccine and autism. However, extensive reports from the National Academy of Pediatrics, the National Academy of Medicine and the CDC concluded that there is no scientifically proven link between the MMR vaccine and autism. In addition, there is no scientific benefit to separating the vaccines.

These organizations note that autism is often identified in toddlers between the ages of 18 and 30 months, which happens to be about the time children are given their first MMR vaccine. But this coincidence in timing typically shouldn't be mistaken for a cause-and-effect relationship.

What’s rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease that can cause joint pain and damage throughout your body. The joint damage that RA causes usually happens on both sides of your body. So if a joint is affected in one of your arms or legs, the same joint in the other arm or leg will probably be affected, too. This is one way that doctors distinguish RA from other forms of arthritis, such as osteoarthritis (OA).

Treatments work best when RA is diagnosed early, so it’s important to learn the signs. Read on to learn everything you want to know about RA, from types and symptoms, to home remedies, diets, and other treatments.

Rheumatoid arthritis symptoms
RA is a long-term or chronic disease marked by symptoms of inflammation and pain in the joints. These symptoms and signs occur during periods known as flares. Other times are known as periods of remission — this is when symptoms dissipate completely.

RA symptoms, which can occur throughout the body, include:

joint pain
joint swelling
joint stiffness
loss of joint function
Symptoms can vary from mild to severe. It’s important not to ignore your symptoms, even if they come and go. Knowing the early signs of RA will help you and your doctor to better treat it.

Rheumatoid arthritis diagnosis
Diagnosing RA can take time and may require multiple lab tests to confirm clinical examination findings. Your doctor will use several tools to diagnose RA.

First your doctor will ask about your symptoms and medical history. They’ll also perform a physical exam of your joints. This will include looking for swelling and redness, and testing your reflexes and muscle strength. Your doctor will also touch the affected joints to check for warmth and tenderness. If they suspect RA, they’ll most likely refer you to a specialist called a rheumatologist.

Since no single test can confirm a diagnosis of RA, your doctor or rheumatologist may use several different types of tests. They may test your blood for certain substances like antibodies, or check the level of certain substances like acute phase reactants that are elevated during inflammatory conditions. These can be a sign of RA and help support the diagnosis.

They may also request certain imaging tests. Tests such as ultrasonography, x-ray exams, and magnetic resonance imaging (MRI) not only show if damage from RA has been done to your joints but also how severe the damage is. A complete evaluation and monitoring of other organ systems might be in order for some people with RA, too. Learn more about the process of diagnosing RA.


Blood test for rheumatoid arthritis
There are several types of blood tests that help your doctor or rheumatologist determine whether you have RA. These tests include:

Rheumatoid factor test: This blood test checks for a protein called rheumatoid factor. High levels of rheumatoid factor are associated with autoimmune diseases, especially RA.
Anticitrullinated protein antibody test (anti-CCP):This test looks for an antibody that’s associated with RA. People who have this antibody usually have the disease. However, not everyone with RA tests positive for this antibody.
Antinuclear antibody test: This tests your immune system to see if it’s producing antibodies. Your body may make antibodies as a response to many different types of conditions, including RA.
Erythrocyte sedimentation rate: This test helps determine the degree of inflammation in your body. The result tells your doctor whether inflammation is present. However, it doesn’t indicate the cause of the inflammation.
C-reactive protein test: A severe infection or significant inflammation anywhere in your body can trigger your liver to make C-reactive protein. High levels of this inflammatory marker are associated with RA.
Find out more about the different RA blood tests.

Rheumatoid arthritis treatment
There’s no cure for RA, but there are treatments that can help you to manage it. Treatments for RA help to manage the pain and control the inflammatory response which can in many cases result in remission. Decreasing the inflammation can also help to prevent further joint and organ damage.

Treatments may include:

medications
alternative or home remedies
dietary changes
specific types of exercise
Your doctor will work with you to determine the best types of treatments for you. For many people, these treatments can help them live an active life and reduce the risk of long-term complications. Learn more about specific RA treatments and how to treat flares.


Rheumatoid arthritis medications
There are many types of medication for RA. Some of these medications help to reduce the pain and inflammation of RA. Some help to reduce flares and limit the damage that RA does to your joints.

The following medications help reduce the pain and inflammation during RA flares:

nonsteroidal anti-inflammatory drugs (NSAIDs)
corticosteroids
acetaminophen
The following drugs work to slow the damage that RA can cause to your body:

Disease-modifying antirheumatic drugs (DMARDs): DMARDs work by blocking your body’s immune system response. This helps to slow down RA’s progression.
Biologics: These new generation DMARDs provide a targetedresponse to inflammation rather than blocking your body’s entire immune system response. They may be an effective treatment for people who don’t respond to treatment with more traditional DMARDs.
Janus kinase (JAK) inhibitors: These are a new subcategory of DMARDs that block certain immune responses. These are drugs that your doctor may use to help prevent inflammation and stop damage to your joints when DMARDs and biologics don’t work for you.

What is rheumatic heart disease?
Rheumatic heart disease describes a group of short-term (acute) and long-term (chronic) heart disorders that can occur
as a result of rheumatic fever. One common result of rheumatic fever is heart valve damage. This damage to the heart
valves may lead to a valve disorder.
Rheumatic fever
Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the
heart, joints, brain or skin. It usually starts out as a strep throat (streptococcal) infection. Anyone can get an acute rheumatic
fever, but it usually occurs in children between the ages of 5 and 15 years. About 60% of people with rheumatic fever
develop some degree of subsequent heart disease.
Every part of the heart, including the outer sac (the pericardium), the inner lining (the endocardium) and the valves may be
damaged by inflammation caused by acute rheumatic fever. However, the most common form of rheumatic heart disease
affects the heart valves, particularly the mitral valve. It may take several years after an episode of rheumatic fever for valve
damage to develop or symptoms to appear.
Antibiotics can prevent streptococcal infection from developing into rheumatic fever. Any child with a persistent sore
throat should have a throat culture to check for strep infection. Penicillin or another antibiotic will usually prevent strep
throat from developing into rheumatic fever.
Symptoms
Symptoms of heart valve problems, which are often the result of rheumatic heart disease, can include chest pain,
excessive fatigue, heart palpitations (when the heart flutters or misses beats), a thumping sensation in the chest,
shortness of breath, and swollen ankles, wrists or stomach.
Treatment
If heart damage from rheumatic fever is identified in childhood or young adulthood, daily antibiotics may be required until
the age of 25 or 30, to help prevent recurrence of rheumatic fever and avoid the development of infective bacterial
endocarditis, an infection of the heart valves or lining of the heart. Additional treatment will depend on the type of heart
damage.