Fellowship in Head and Neck Surgery (USA)

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• Fellowship in Head and Neck Surgery (USA)
• Fellowship in Neurotology Skull Base Surgery
  (USA)
• Senior Consultant in ENT-Head and Neck
• and Neurotology
• Apollo Hospitals, Bangalore

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In India

• It is estimated that around 40 of the men and
  15 of the women use tobacco on a regular basis.
• However, in certain areas of the country regular
  use increases to over 85 in men and over 65 in
  women (including smoking and chewing).

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Facts and Figures

• Most prevalent age - 25-44 years
• Average age to start smoking is 14.6 years
• Tobacco is the most preventable cause of head and
  neck cancer deaths.
• Use of tobacco (cigarettes, paan, chewing tobacco
  or snuff) is closely linked with cancers of the
  mouth, throat, voice box and tongue.
• There are 4,000 substances found in cigarettes
  and 43 of them are known to cause cancer .

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Ingredients in cigarettes

• Polonium210 (nuclear waste)
• Acetaldehyde (irritant)
• Lead (nerve poison)
• Formaldehyde (embalming fluid)
• Cadmium (found in batteries)
• N-Nitrosamines (known carcinogen)
• Benzopyrene (known carcinogen)
• Uranium 235 (nuclear waste)
• Nicotine (addictive substance)

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Health Consequences of Nicotine Exposure

• Accelerated coronary and peripheral vascular
  disease
• Increase in heart rate (30 higher)
• Stroke
• Hypertension
• Smokeless tobacco users had 2.5 times increase in
  cholesterol

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Effect of Tobacco on Pregnancy/Birth

• Hypoxemia of fetus
• Spontaneous abortion
• Placental disruption
• Preterm delivery
• Decreased milk production
• Birth defects (cleft lip or palate)
• low birth weight.

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• If you smoke or are around second-hand smoke
  while you are pregnant, you are more likely to
• deliver early
• experience problems during labour
• if youre breast-feeding -gt some chemicals are
  passed directly from breast milk to the baby.
• baby has higher risk of dying during childbirth
  or dying of SIDS (sudden infant death syndrome).

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What is second-hand smoke?

• Second-hand smoke is the smoke from a burning
  cigarette, pipe or cigar.
• Also known as environmental tobacco smoke
• ETS contaminates the air and is retained in
  clothing, curtains and furniture.
• Cigarettes produce about 12 minutes of smoke, yet
  the smoker may inhale only 30 seconds of smoke
  from their cigarette. The rest of the smoke
  lingers in the air for non-smokers to breathe.
• When someone smokes inside a home or car,
  everyone inside breathes second-hand smoke.

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Effects of ETS

• It is unpleasant, annoying, and irritating to the
  eyes and nose
• headaches, coughing and wheezing, nausea and
  dizziness.
• colds, bronchitis and pneumonia.
• Long term exposure ?heart problems, breathing
  problems and lung cancer.

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Effect of ETS on Children

• coughing and wheezing
• asthma and other breathing problems
• bronchitis and pneumonia
• higher risk of heart disease

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• increases both the number and the duration of ear
  infections - the most common cause of children's
  hearing loss
• take up smoking themselves.
• impairment in school performance and intellectual
  achievement has also been demonstrated.

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• World Health Organizations International Agency
  for Research on Cancer (IARC) have all classified
  secondhand smoke as a known human carcinogena
  category reserved for agents for which there is
  sufficient scientific evidence that they cause
  cancer

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• the risk of developing cancer from ETS is about
  100 times greater than from outdoor
  cancer-causing pollutants
• Did you know that ETS causes more than
• 3,000 non-smokers to die of lung cancer each year!

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Facts about Smokeless Tobacco A Dangerous
Alternative

• Smokeless tobacco is highly addictive
• It is the leading cause of oral cancer
• It kills at a younger age than cigarettes
• It has 100 times higher concentration of
  cancer-causing agents than cigarettes
• Most commonly used by 18-25 age
• 28 substances in this are known to cause cancer

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• Statistics show that every year 8,00,000 new
  cancer cases are registered
• 3,20,000 of which are suffering from Head and
  Neck cancers largely attributed to tobacco
  habits.
• While, tobacco claims about 4.9 million deaths
  annually globally, an alarming 1 million of them
  are from India.

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• Head and neck cancers are common in India and
  account for about 30 of cancers in males and
  about 13 in females.
• In the Western world in general, it accounts for
  less than 10 of all cancers
• The primary reason for this unusually high
  incidence is the indiscriminate use of tobacco in
  its various forms

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The overall survival rate for head and neck
cancer in the general population is only 52, a
rate which is worse than uterine, breast,
cervical and colon cancers With early detection
and treatment, the 5-year survival rate can
increase up to 85.
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Warning Signs

• A sore on the lip or in the mouth that does not
  heal
• A lump on the lip or in the mouth or throat
•   A white (leukoplakia) or red patch on the gums,
  tongue or lining of the mouth
• Unusual bleeding, pain or numbness in the mouth
• A sore throat or a feeling that something is
  caught in the throat
•   Difficulty or pain with chewing or swallowing
•   Swelling of the jaw that causes dentures to fit
  poorly or become uncomfortable

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• A change in the voice or hoarseness
•   Pain in the ear without evidence of local ear
  problems
•   Slurred speech
•   Loose teeth not associated with any gum
  problems
•   Swelling, numbness, paralysis of the muscles in
  the face
• Chronic sinus infections that do not respond to
  treatment with antibiotics
• Bleeding through the nose, frequent headaches,
  swelling or other trouble with the eyes.

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Tips to quit tobacco

• Remember, most people dont start on their own,
  so dont try quitting on your own.
• Ask for help and positive reinforcement from your
  friends, parents, coaches, teachers, whomever...

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Tips to quit tobacco

• Think of reasons why you want to quit.
• Pick a quit date and throw out all your tobacco
  and ashtray.
• Tell yourself out loud every day that youre
  going to quit.
• Find alternatives to tobacco. A few good examples
  are sugarless gum, fruits, raisins or dried
  fruit.
• Notice when and where you use tobacco. Plan other
  things to do at those times.
• Delay the act, count till 100
• Substitute stimulus associated with tobacco i.e.
  tea can be replaced by milk or juice.

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Tips to quit tobacco

• Find activities to keep your mind off tobacco.
  You could ride a bike, talk or write a letter to
  a friend, work on a hobby, or listen to music.
• Do something else when you feel the urge to
  smoke/ chew tobacco. This will help you keep your
  mind off tobacco.
• Exercise can help relieve tension caused by
  quitting.
• Set realistic goals and achieve them.
• Don't give in to cravings. These usually last for
  only 3-5 minutes.

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Tips to quit tobacco

• Deep breathing When you were smoking, you
  breathed deeply as you inhaled the smoke. When
  the urge strikes now, breathe deeply and picture
  your lungs filling with fresh, clean air.
• Increase your water intake.
• Take small sips of water when the urge to
  smoke/chew is high.
• Reward yourself. You could save the money that
  would have been spent on tobacco products and buy
  something nice for yourself.

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Motivating Patients to Quit

• Improved health
• Food tastes better
• Improved sense of smell
• Save money
• Feel better about yourself
• Home, car, breath will smell better
• Can stop worrying about quitting

• Set a good example for children
• Healthier babies and children
• Not worry about exposing others to smoke
• Feel better physically
• Freedom from addiction
• Perform better in sports

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Nicotine Withdrawal Symptoms

• Withdrawal peaks in 2 days and lasts up to 1-2
  weeks (on average)
• Depressed mood, sadness
• Insomnia
• Irritability, frustration, anger
• Anxiety
• Impaired concentration
• Restlessness
• Increased appetite

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Once You Quit

• Learn to say no to tobacco offers from others.
• Dont take even one puff.
• Try to remain in smoke free areas. Avoid company
  of smokers and chewers.
• Make a group of people who have quit tobacco.
• Try alternative ways to deal with stresses
  Relaxation, deep breathing, listening to music,
  exercises, taking a walk, talking to someone over
  telephone etc
• Even if you fail in your attempt- Try again

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Are you ready to Quit?