Medical Results

In  the ENT (otolaryngology) department the specialized consultations are given by  :

DR. MURESAN CAMELIA

DR. MARIN LAVINIA

DR. CATANA IULIU

DR. VLAD DIANA

DR. GABRIAN MIHAI ADRIAN

 

ENT PATHOLOGY 
 

Otolaryngology is the medical name for ears, nose and throat, that we find abbreviated on the medical cabinet's door: ENT. Due to the fact that our eras, nose and throat have an internal and an external segment, the specialized consult implies observing both segments, that being the reason the doctor is equipped with a mirror as light source on his head, and other optical systems and equipment with the help of which he sees the hidden zones: auditory channel, eardrum, nasal cornets, rhinopharinx or larynx wit vocal cords. Although at first sight all this equipment seems scary, none of the manoeuvres are dangerous  .

 

OTITIS MEDIA
 

The infection of middle ear (otitis media) is an inflammation or an infection of the middle ear. The infection often starts when a flu causes a swelling and closing of the connection tube between the middle ear and throat, tube the is called Eustachian tube. The liquid, that normally flows, in case of a flu is accumulated in the middle ear. The bacteria and viruses are incubated in the middle ear and causes the ear to infect . 

 

This condition is often met in small children, because in their case, the Eustachian tube is shorter and more easy to block than in adults or bigger children.
 

There are two types of otitis media:

-acute otitis media is an infection of the middle ear. In case of infection pain appears (sometimes severe). Other times fever is present.

-suppurative otitis media is the accumulation of a secretion in the middle ear, without the infection.

The child might not present symptoms of the disease, but the secretion might determine loss of hearing or the sensation of "clogged ear". 

Causes
 

The infection of middle ear is caused by bacteria and viruses. In cold weather, in the presence of sinus or pharygeal infection, or in in an allergy episode, the Eustachian tube that connects the middle ear and the throat can be blocked. This situation stops the drainage of the middle ear secretions. These secretions are a favourable environment for bacteria and viruses that determine the infection of middle ear.

The bacterial infections represent aprox. 65-76% of all ear infections. The most frequent bacteria are Streptococcus pneumoniae ( also met under the name of pneumococcus), Haemophilus influenze and Moraxella catarrhalis.

Viral infections- viruses that can determine ear infections. The most frequent virus is respiratory syncytial virus followed by flu viruses.

In an inflammation determined by a superior respiratory tube infection or allergic manifestation, the Eustachian tube is blocked and the air can not enter in the middle ear. This creates a void and aspiration of secretions from an infection or allergy toward the middle ear. Then, the inflammation stops the secretion from evacuating. The infection of the middle ear appears when in these secretions bacteria incubates.

Inflammation and secretion accumulation could appear without infections and determine the sensation of "clogged ear". This form is called suppurative otitis media.

 

Risk factors

There are factors that can't be controlled  that determine an increased risk for middle ear infections (otitis media). These include:

-age. Children smaller than 3 years old are predisposed to middle ear infections. Also, small children develop superior respiratory tube infections and colds frequently. The majority of children have at least one middle ear infection in the first 7 years of their life.

-congenital defects or other medical problems. Nurslings with cleft palate or Down syndrome are predisposed to meddle ear infections.

-lean immune system. Children with severely affected immune system develop middle ear infections frequently.

-sex. Apparently boys develop middle ear infections more frequent than girls.

-family history. Children are more predisposed to develop repeated middle ear infections if the parents or their relatives had this kind of infections.

-allergies. Allergies can be considered risk factors for middle ear infections. Allergies determine a clogged nose, that disturbs the functioning of the Eustachian tube. Through its blocking, the secretions are accumulated in the middle ear.

 

Other factors that increase the risk to develop otitis media are:

-frequent virosis and superior respiratory tube infection. Most of the middle ear infections are developed because of colds ad other superior respiratory tube infections.

-exposure to cigarette smoke. Nurslings that are exposes to cigarette smoke develop middle ear infections more frequent than nurslings that are not exposed to this noxa. Even more, the ear infections of the children that are exposed to cigarette smoke have a longer evolution.

-feeding bottle alimentation. Nurslings that receive their milk from the bottle are more predisposed to middle ear infections in their first year of life that the nursling that are breast fed. Even more, the nurslings that receive their milk from the bottle in a horizontal position develop middle ear infections more frequent than the ones that are held in the correct, vertical position.

-children from foster centers. Children from foster centers, due  to the fact that they are constantly around other children, develop middle ear infections more often than those who are raised in a home.

-using the pacifier. Children that use the pacifier for a long time are more predisposed to middle ear infections that the children who don't have this habit.

 

From the factors that favor repeated meddle ear infections:

-ear infections at a small age. Nurslings that develop their first middle ear infection in the first 6 months of life are more predisposed to develop this infection repeatedly.

-ear secretion persistency. Secretion that persist, behind the eardrum, for a period of 2-10 weeks after an infection increase the risk for repeated middle ear infection.

-anterior infections. Children that had an ear infection less than 3 months ago, are more predisposed to another ear infection, especially if that infection was treated with antibiotics.

 

Symptoms

 

The middle ear infection symptoms (otitis media) usually appear after 2-7 days from a virosis or a superior respiratory tube infection. The symptoms or a ear infection could be:

-ear pain (from a medium pain to a severe one). Nursling usually pull their ear when they feel this pain. When secretion is accumulated in the middle ear, the eardrum might break.

 

Once the eardrum is broken, the secretion flows and the pain usually stops. Eardrum breakage is healed after a few weeks

-fever

-the secretion is thin and yellow. If the secretion contains blood, it is a sign that the eardrum is broken

-loss of appetite, vomit, bad-temper

-sleep disorders

-loss of hearing is possible

 

The symptoms of secretion accumulation include:

-cracks, or the sensation of ear pressure. Children often have difficulties in describing the symptoms. Children pull their ears trying to ease their suffering.

-loss of hearing. Children the lose their hearing can seem dreamy or absent-minded

-dizziness or loss of equilibrium

Some children don't present any of these symptoms.

 

SINUSITIS

Sinusitis are infections  of the mucous membrane that cushions the interior of the nasal pits and sinuses. The sinuses are empty spaces, or cavities localized around the eyes, cheeks and nose.

When the mucous membrane is inflamed, bruised, it blocks the fluid drainage from the sinus to the nose and throat, determining pain and pressure in the sinuses. The bacteria and fungi grow, most probable, in the sinuses that are incapable to drain correctly.

The sinuses become blocked during viral infection and cold, having as result the sinus infection. The difference between the cold and the sinusitis is that the symptoms that come with the cold, including clogged nose, start to better after 5-7 days. The sinusitis symptoms last longer and become worst after 7 days.

There are two types of sinusitis: acute (with sudden debut) and chronic (long term). In the case of chronic sinusitis, the symptoms do not disapear completely, always maintaining easy symptoms.

 

Causes

The sinusitis is the most frequent result of viral infection, that determine the inflammation of the mucous membrane that cushions the interior of the nasal pits:

-the mucous membrane is bruised when becomes inflamed, blocking the drainage of the fluid from the nose or throat

-the mucus and secreted fluid in the sinuses causes pressure and pain

-the bacteria have a favourable environment for incubating in the sinuses that do not drain correctly; the bacterial infection of the sinuses is often determined by the inflammation, more than the pain.

While the colds trigger this affection, any factor that determines the inflammation of the mucous membrane, can lead to the apparition of sinusitis. Many persons with allergic rhinitis (nasal allergies) present, most probably, chronic sinusitis with repeated episodes of acute sinusitis. The nasal polyps, foreign bodies (most frequent in children), structural nose affections, as deviated septum and other diseases, can obstruct the nasal passage, increasing the risk for sinusitis.

The fungal infections can also cause sinusitis. These are more frequent in children with a weak immune system. Fungal sinusitis have the tendency to get chronic and are more difficult to treat than the bacterial ones..

 

Symptoms

Pain and pressure at face level, together with the sensation of clogged nose or full of secretion nose, are the most frequents symptoms. The apparition of a yellow-green secretion can be observed. Leaning or moving the head can increase the facial pain and pressure.

Localizing the pain or the sensibility depends of the affected sinus:

-pain in the cheeks and incisor teeth is often caused by the maxillary sinus inflammation

-pain in the forehead, over the eyebrows, can be caused by the inflammation of the frontal sinus

-retro-ocular pain (behind the eyes), in the top of your head and in both temples, can be produced by the inflammation of the sphenoid sinus

-pain around the orbit or retro-ocular is determined by the inflammation of the ethmoid sinus

Other usual symptoms of the sinusitis are:

-cephalalgia

-yellow or green secretions that flow from the posterior part of the throat

-halitosis (bad smelling breath)

-productive cough

-fever

-dental pain

-the diminution of taste and smell sensitivity.

 

Acute sinusitis (with sudden debut)is usually caused by a viral infection and it often develops fast. It usually lasts for 4 weeks or less, and the symptoms start to disappear in a week, without treatment. Acute sinusitis produced by a bacterial infection is less probable to heal by itself, and can lead to the apparition of chronic sinusitis or complications where the infection spreads far from the sinuses. Nasal secretions that contain pus and that aggravate after 5 days, or last for more than 10 days represent a solid argument for acute sinusitis produced by a bacterial infection.

 

Chronic sinusitis  is, usually, caused by a bacterial or fungal infection. This infection can be difficult to treat. If chronic sinusitis is not healed after use of two different antibiotics, the doctor must be consulted for the necessity of surgical intervention or allergy tests. Chronic sinusitis can lead to the apparition of permanent modifications of the mucous membrane that cushions the sinuses, and predisposes to repeated sinusitis.

 

Symptoms of sinusitis in children include: cough, nasal secretions that persist more than 7-10 days, cephalalgia and pain in the face level. Many children, older than 2, with chronic sinusitis, can present frequent allergies or otitis (ear inflammation) Certain vaccines, especially the pneumococcal conjugate vaccine  (PCV 13) and the vaccine for type b Haemophilus influnzae (Hib), can help in the otitis and sinusitis prophylaxis.

 

Other affections that have similar symptoms are allergies, dental pains, colds, and other infections of the superior airways. If the cold comes back or aggravates after 7 days, most probably there is a sinusitis or other superior airways infections.

 

Investigations

The sinusitis diagnosis is usually based on patient history and objective exam. A detailed patient history, is usually more useful for the diagnosis that the objective exam. If the symptoms and signs that are found are typical of sinusitis, other tests are not required.

Additional tests can be made if:

-the diagnosis is not clear

-the antibiotics treatment failed to treat the affection

-complication (such as osteomyelitis) appear

-surgical treatment is considered

 

The imaging tests can be used if the sinusitis symptoms persist or are recurrent in spite the treatment, or when tumors or other lesions are suspected as cause of the frequent epitaxis:

-head and throat CT: gives detailed images of the sinus structure, CT could help to evaluate chronic sinusitis, and identify the complications of sinusitis, or exclude other affections. This method is used to diagnose acute sinusitis

-sinus radiography: can be made to confirm the sinusitis: a Rx examination is an image of the dense tissues from inside the body; but a CT scan gives a more exact information.

 

Sometimes, other investigation can be made by the ENT doctor or an allergologist. These investigations include:

- endoscopic examination of the sinus (nasal endoscopy): nasal endoscopy uses a light source instrument, called endoscope, to visualize the interior structures of the nose and sinus cavities, nasal endoscopy is used to evaluate chronic sinusitis

- an aspiration puncture with small needle

- MRI: a MRI must be done is there are reasons to suspect that the infection is spread; can be useful for the discovery of formations or tumors inside the nasal pits or sinuses .

 

Treatment - Generalization

Sinusitis is treated with drugs and home care measures, like aerosols (inhalations). The treatment's objectives are:

-improving the mucus drainage, avoiding the permanent lesion of the tissue that cushions the nose and sinuses

-fighting pain and pressure

-killing all infections

-preventing the formation of scars, avoiding permanent lesion of the tissues

 

The medicines must be used daily to treat sinusitis, especially when the cause in bacterial infection. The medicine treatment could be shorter than 3 days or longer, for a few weeks or more. The used medicines include a combination of:

-antibiotics- like amoxicilin will destroy the bacteria

-decongestants- diminish the inflammation

-analgetics- like aspirin, ibuprofen to kill the pain

-corticosteroids

-mucolytics- that dilute the mucus

 

The inhalant antibiotics are a new method of treatment for chronic sinusitis. The initial tests have shown that because the inhalant antibiotics come in direct contact with the mucous membrane, they can be more effective if other forms of treatment fail.

The development of a "double illness" is possible during the treatment. In the beginning, the symptoms get better after the antibiotics treatment, but later the symptoms get worse and an additional treatment is necessary.