What dangers lurk in the summer

Interview with a specialist in the field of diseases of the ear, nose and throat, professor New Y Eye and Ear Infirmary

IGOREM BRANOVAN

A wonderful time of the year has come - summer. You can enjoy all the gifts of nature - swim, sunbathe and get a variety of other pleasures associated with recreation. But no wonder they say that each medal has a downside. What kind of "downside" can summer be for us from the standpoint of a otolaryngologist, a doctor who stands guard over our health both in winter and in summer?

We asked this to tell the readers of the newspaper an otolaryngologist, Professor Igor Branovan.

IGOR BRANOVAN: Naturally, we have to deal with various diseases of the ear, nose and throat all year round. However, summer has its own clear specifics of the diseases that occur most often. Therefore, I would like to introduce our readers to them. I hope this can prevent many of them, especially in children.

It is primarily about two types of diseases. The first are various injuries to the face, nose, throat, and bones of the facial part of the skull. In the summer they occur much more often. The second type of disease should include inflammatory diseases of the ear, nose and throat, which are quite common in other seasons, especially in children. However, in summer, both children and adults spend a lot of time on the banks of reservoirs and in the water of ponds, rivers, and seas. This greatly increases the development of various inflammatory diseases of the nasopharynx and ears.

As for injuries, we often have to deal with injuries to the bones of the face — the nose, jaws. But most often - with injuries of the nose. The base of the nose on 1 / 3 is the bone (upper part), on 2 / 3 - the cartilage. The same structure and the nasal septum - the back of it - the bone (1 / 3); the front part consists of cartilage (2 / 3). By analogy with the flexibility of the cartilaginous base of the ear, the nose also has a kind of “memory”. If the nose is bent and then released, it will immediately take the same shape. If the nasal cartilage is injured and a lot of time has passed after the injury, then it is not easy to restore the former shape of the nose. Therefore, for fractures associated with damage to the cartilage, you should begin treatment without any delay, which, unfortunately, does not always happen.

Let's take a typical case as an example: a person slipped, fell face down and injured his nose. It is very important to make a timely and accurate diagnosis, to find out whether there is a fracture. The most common symptom of a fractured nasal bones is bleeding from the nose, as well as the appearance of “bruises” under the eyes. There are practically no cases when bruises under the eyes do not occur when a bone is damaged. And bleeding indicates that the tissues of the nose and, possibly, the septum itself are damaged in the area of ​​the septum. The danger is that a hematoma can form - an accumulation of blood around the septum. This makes breathing difficult, but more importantly, a hematoma can significantly reduce the blood supply to the tissues of the nose, especially the septum. Therefore, if qualified assistance is not provided by an otolaryngologist within 1 to 2 days, then the lack of blood supply can lead to the death of cartilage. It is almost impossible to restore it after this.

Everyone understands that the preservation of the nose and its functions is important not only from a purely medical point of view, but also from an aesthetic one. We can not ignore this fact.

Therefore, timely diagnosis of damage to the nose, especially its septum, is doubly important. As a rule, to determine whether the nose and nasal septum is damaged, it is enough for us to examine the face of the victim carefully enough. An X-ray will objectively confirm the diagnosis of a fracture, but if there is no doubt about a fracture, an X-ray is not necessary.

It is possible to restore the position of the damaged bone septum of the nose (“right” it into place) either immediately after the fracture, or after a certain time. The fact is that within a few hours after the injury, a strong swelling of the tissues (“tumor”) develops at the injury site and then in the subsequent 5 - 6 days active intervention is undesirable. During this time, as a rule, the puffiness subsides, and no later than a week, we can and should correct the shifted bones of the nose, often without even resorting to surgery. If this correction is carried out at a later date, then there may be a curvature of the bony septum and cartilage. Not to mention the appearance, it is fraught with such an unpleasant complication, as difficulty breathing.

Now I want to turn to the issue of inflammatory diseases of the ear, nose and throat, which we so often encounter in the summer. Often bathing and especially immersion in water lead to the development of an infection of the outer ear (otitis externa). Infection that affects the outer ear and the auditory meatus is caused by a bacterial environment, which, unfortunately, is found in quite significant amounts of ponds and rivers in the water. Less commonly, this is due to seawater.

— Is this caused by damage to the skin in the outer ear?

- Not always, but most often. This is facilitated by weakened body resistance in some children, minimal damage to the skin of the auricle and ear canal. But even in healthy people, immersion in water for a long period of time is fraught with the occurrence of an infection of the outer ear. What are the possibilities for diagnosing, preventing and treating such inflammatory diseases?

A very simple and typical symptom of external otitis is the appearance of pain when touching the auricle. It must be remembered that this symptom is not related to inflammation of the middle ear and does not occur with it. The patients also complain of a feeling of stuffiness in the ear, swelling, as well as purulent discharge from the ear, sometimes even with an admixture of a small amount of blood.

In the treatment of otitis externa, we often use antibiotics in the form of ear drops. With strong edema of the ear, we apply hydrocortisone topically. Treatment usually takes 1 - 2 week. It is important to remember that the ear should be dry, so when bathing under the shower, the sore ear is laid with cotton wool with petroleum jelly, and it is even better to put a rubber cap on the head. When treating with the help of some drops, one must be firmly convinced that the drops fall into the ear, that is, that the ear canal is not blocked by inflammatory edema, because in this case the medicine does not reach the destination. If you or your child has external otitis and there is a suspicion that the medicine does not reach the goal, it is necessary to go to the otolaryngologist without delay. Only he is able to check the patency of the auditory canal under a microscope. If it is closed (edema, pus), the doctor will insert a special cotton swab into it with which the patency of the auditory canal will be restored. An infection of the outer ear is especially dangerous for the elderly, as well as diabetics. In them, the infectious process is rapidly progressing, which in some cases can lead to the development of osteomyelitis of the bones of the skull, to sepsis and even death.

To avoid the development of an infection of the outer ear, after bathing, a weak solution of acetyl (acetic) acid, which is sold in a pharmacy without a prescription (Burow's solution), can be instilled into the ear. There are other similar actions of the drug in the drops. If you are in places where there is no pharmacy nearby, you can use a solution of household vinegar. It must be diluted with boiled water at the rate of 1: 1. Such a solution also acts prophylactically very reliably. The history of its application is interesting. Back in the 60 of the twentieth century, infections of the outer ear caused a lot of trouble for soldiers and officers of underwater units of the American army. Experiments conducted by physicians helped find a way out: for the purpose of prevention, they successfully used weak solutions of acetic acid. In addition, these drops do not dry the skin. It must be remembered that after dropping drops it is necessary to keep the head bowed for at least 10 minutes.

— Can deep diving underwater cause any health problems?

— Complications associated with diving, fortunately, do not occur often, but you need to remember and be aware of them. The deeper a person dives, the greater the atmospheric pressure around him. In fresh water in lakes and rivers, the pressure doubles approximately every 33 feet (about 11 meters). Accordingly, the water pressure on the eardrum doubles. If there is no damage on the inside of the eardrum, and also if there is no damage in the eustachian tube, then the air pressure in the inner ear is equalized according to the pressure in the outer ear. If there is damage to the Eustachian tube, and most often this is an inflammatory process, then the pressure is not equalized and the eardrum may rupture. In this case, cold water penetrates into the middle ear, causing very unpleasant sensations, especially severe dizziness, at which point the person may lose consciousness and drown. Even if the consequences are not so catastrophic, then still the consequence of a ruptured membrane will be the accumulation of fluid behind the eardrum, i.e. in the cavity of the middle ear, the development of inflammation (otitis) here. A dangerous consequence of increased pressure in the middle ear can be damage to the inner ear. This occurs when there is a sudden change in pressure, for example during straining associated with lifting weights, sometimes even with constipation. A crack appears in the thin membrane separating the inner ear from the middle ear. Through it, fluid begins to leak into the cavity of the inner ear, which is normally found in small quantities in the cavity of the middle ear. A symptom of this is severe dizziness and hearing loss. In such cases, immediate surgical intervention is needed to eliminate the crack in the membrane. Otherwise, the victim may permanently lose hearing and have permanent imbalances in space. These disorders occur more often in people involved in underwater sports. In people who have nothing to do with this, such disorders occur much less frequently.

A certain pressure drop occurs in the passengers of the aircraft when the aircraft is landing. Many of the readers probably know this feeling: suddenly lays their ears, hearing decreases. Usually these phenomena quickly pass. As a rule, they occur in people suffering from chronic inflammation of the nasopharynx, accompanied by inflammation of the auditory (Eustachian) tube connecting the nasopharynx and the middle ear cavity.

— Unlike many otolaryngologists who treat various diseases of the ear, nose and throat, you, in addition to these diseases, as far as I know, are seriously involved in the diagnosis and treatment of such serious injuries associated with water procedures.

- This is true. Many people involved in underwater sports come to me and I have accumulated significant experience in treating them. In addition, to a certain extent this is helped by the fact that I myself am fond of scuba diving.

In conclusion of our conversation I want to remind all lovers of rest “on the water”: I fully agree with the words of the old song that “the sun, air and water are useful to us”. But do this with caution and caution, watch the behavior of children. Then rest will bring you only joy and health.