If winter, then respiratory infections?

Few of us will pass an entire winter without contracting a respiratory infection.  Unfortunately, many of us do not take these unpleasant illnesses seriously enough considering that even the most trivial common cold can turn into complications which will then require help from an otolaryngologist.  We asked Éva Székely, MD, otolaryngologist, to inform us regarding the most prevalent winter disorders.

The number of persons seeking help from an ENT doctor increases markedly during the winter months.  What are their most prevalent complaints?

Besides respiratory symptoms, colds, stuffy nose, catarrh and laryngitis, the most prevalent complaints are excruciating headaches, high temperature and serious earaches that may be accompanied by temporary hearing loss.  The latter symptoms indicate that bacterial complications of the respiratory infection did not only develop in the nasal cavities but also in the maxillary and frontal sinuses as well as the ear canals (Eustachian tubes).  Sinus and middle ear infections are the most common.

The Patient suffering from infections, colds and influenza usually has a feeling of general malaise and a headache.  How can we tell that this is more than a trivial cold and that the infection has spread to the sinuses? 

We can tell a sinus infection when the nasal discharge is no longer clear but yellowish-greenish in color, there is fever, a strong coughing impulse, headaches, facial tension and the sinuses are painful and sensitive to pressure.

Sinus infections (sinusitis maxillaris) are not uncommon.  Just about everyone contracts it at least once in their lifetime and some, due to anatomical reasons (narrow canals, nose polyps, septum deviation) may contract it more often.

Sinusitis is defined as inflammation of the mucous membrane that lines the paranasal sinuses beginning, in the majority of cases, with inflammation of the nasal mucous membrane, cold symptoms and a plugged nose.  The increased amount of nasal discharge occurring in these cases cannot exit properly due to the swollen nasal mucous membrane collected in the sinuses causing tension pain in the face and headaches.  The stagnant nasal discharge in this closed, warm and damp area is ideal for the propagation of inflammatory bacteria.  The process strengthens itself since the swollen sinus mucous membrane also prevents the ever deepening discharge amount from emptying.

What steps can be taken in the case of sinusitis?

In a nutshell:  nasal spray, warmth, mucolytics!

In detail:  the treatment first of all concerns the emptying of the accumulated discharge with a nasal spray or nose drops order to shrink the swelling.  Nasal spray with steroids is also often required.  Dry heat (Sollux lamp), vaporizer for cough and mucolytics to dissolve the thickened discharge is advised.   Bacterial infection often requires antibiotics.  In long lasting and recurring cases it would be worthwhile to check for possible anatomical causes together with a thorough ear, nose and throat examination.  Other factors such as iron deficiency anemia and vitamin D3 deficiency should be tested and treated.

Every parent’s nightmare is the child waking in the middle of the night crying bitterly and complaining of an earache.  What is the cause and how can it be prevented?

In children, middle ear infections do often follow upper respiratory tract infections that began with a cold and laryngitis.  In small children, the sinuses are near the tubes connecting the middle ear (Eustachian tubes) and the nasopharynx allowing the inflammation of the mucous membrane to easily pass through.  Acute purulent middle ear infections are one of the most common illnesses among preschool children.  In these cases, the inner mucous membranes of the Eustachian tubes also become inflamed and swollen, narrowing and closing the exit route, preventing the stagnant inflamed discharge in the tympanic cavity from emptying and causing the discharge to build up and painfully strain the eardrum.

The main symptom of the illness, especially in children, is intensive pain together with fever, restlessness, nausea, vomiting, plugged ears and decreased hearing.  When diagnosed in time, mild analgesics for middle ear infections, nose drops and antibiotics will cure the inflammation in a few days.  Should the inflammation last more than one week, the pain persists or the complaints recur, it would be advisable to consult an otolaryngologist since the course and cause of a middle ear infection might be several.  The cause may not necessarily be respiratory infection but the temporary or chronic dysfunction of the Eustachian tube connecting the nasopharynx with the tympanic cavity or the acute, chronic inflammation of an enlarged adenoid.  Anatomic disorders of the nose and sinuses (polyps, septum deviation, etc.) cause problems principally in adults.

An untreated, recurring acute middle ear infection and stagnant, thick discharge in the tympanic cavity cause hearing loss in children restricting their speech development and affecting their school performance.  Thus, prevention, examination (hearing examination and tympanometry) and treatment are very important.