Doc257

My ear hurts – from swimming too much?

Such an earache can cause a lot of pain : its severity is generally not in proportion to the small organ which the ear actually is. Earache refers to a pain or severe discomfort which is felt in the ear, and sometimes even may be felt in the jaw, the skull, or the neck, the problem might be located in any part of the ear, in the earlobe, in the ear canal, or in the middle ear.

Occasionally however, this pain can also be a referred pain, and may for instance originate in the neck, or in the jaw and trigger a pain in the ear.

Even a mild infection, accompanied by a certain degree of inflammation in the ear can produce disproportionately severe pain and tenderness!!!!

I will go over the main conditions which I frequently encounter here in the Costa del Sol, and especially in the summer.

And let me start by saying that simply buying drops over the counter, without a qualified and experienced medical professional having looked into the ear, and thus no correct diagnosis having been made, is silly. I will explain this later in this article.

  1. Pain caused by a problem in the ear.

The pain which has its origins in the ear can be caused by several diseases or pathological processes in the respective anatomical parts of the ear:

  1. The Earlobe.

The most common causes are trauma, like a blow to the ear, and infections of either the cartilage or the skin of the earlobe, for instance due to an insect bite, or from scratching.

This is rarely the cause of earache, since it is such an obvious and visible area it will in most patients show immediately.

Treatment must be prompt to avoid a permanent deformity of the earlobe: an example of this are the cauliflower ears of rugby players. 

  1. The Ear canal.

Several processes can be causing pain or discomfort here.

Firstly there are the obstructions of the ear canal, they may be caused by, for instance, wax, (there can be itching, pain, loss of hearing and a feeling of pressure, often aggravated by water, which causes the wax plug to swell), or an acute infection of the ear canal, since it can also cause a feeling of obstruction due to a build-up of pus, or a foreign object (small children especially are prone to this: they often put beads, beans etc. in their nostrils and ears). Occasionally an insect can crawl into the ear canal, or fly into it, and this surely needs medical evaluation and treatment.

Wax is the most commonly occurring cause of obstruction and earache. The treatment consists obviously of the removal of this obstruction, usually by syringing, or microscopic cleaning, but this should be performed only after proper inspection and preparation, a crucial error is to buy wax-dissolving eardrops at the Pharmacy, over the counter, without prior inspection and evaluation by a doctor, and then to put these drops into an ear canal, they may well aggravate or even provoke an ear infection.

Secondly, infections of the ear canal (like swimmers ear) are a frequent cause of earache, especially here in the hot summer. As the name indicates, such an infection is very common during the summer swimming season, the combination of earwax, or any type of dirt in the ear canal, water/humidity, and elevated temperatures form an ideal culture-medium in which bacteria will thrive!

These infections in the ear canal can be either localised (like an abscess), or more diffuse, spread out, when the whole ear canal is involved. And, poking in the ear with an ear bud will aggravate the infection even more.

Here are some of the types of Otitis Externa (OE) which we commonly encounter:

Acute diffuse OE - Most common form of OE, typically seen in swimmers.

Acute localized OE (furunculosis) - where an abcess has formed.

Chronic OE - Same as acute diffuse OE but is of longer duration (>6 weeks).

Eczematous (eczematoid) OE - Encompasses various dermatologic conditions (eg, atopic dermatitis, psoriasis, systemic lupus erythematosus, and eczema) that may cause OE.

Necrotizing (malignant) OE - Infection that extends into the deeper tissues, occurs rimarily in immunocompromised adults (eg, diabetics, patients with AIDS)

Otomycosis - Infection of the ear canal by a fungus.

The symptoms will vary according to the condition, but usually are itching, pain, sometimes a discharge from the ear, and even loss of hearing, due to swelling or the build-up of infectious material in the ear canal. The pain can even be so severe that it prevents the patient from sleeping on the affected side, and may drive the sufferer on the wall from the pain!!!

The indicated treatment here consists of:

Pain management.

Removal of debris from the ear canal.

Administration of topical medications to control edema and infection.

Avoidance of contributing factors.

Very rarely, in my experience, are oral antibiotics effective, and thus used or needed less than five times each year.

These are the main problems related to the ear canal which I tend to encounter here in the summer; and it is important to properly distinguish between them and treat them accordingly.

  1. The Middle Ear.

The main condition responsible for ear ache here is an infection of the middle ear, better known as otitis media. This usually is accompanied by fever, sore throat, itchiness in the ear ,cough and pain on swallowing. Flying can often aggravate this condition; children in particular are prone to it.

Otitis media is a chapter on itself; the treatment may consist of antibiotics, and drugs to reduce the inflammation; achieving this will relieve the pressure on the middle ear and thus alleviate the pain.

  1. Pain caused by problems outside the ear, the so-called referred pain.

In the vast majority of people suffering with such a pain, the symptoms are due to a malfunctioning of the temporo - mandibular joint (this means the joint between the skull and your jaw-bone). The actual problem may be found in this joint itself, or in the surrounding muscles. It affects especially women in their thirties, and possible causes are incorrect chewing, or excessive grinding of the teeth.

In a second group of these referred pains, the pain is due to dental problems, mainly in the lower jaw, and specifically the wisdom teeth.

Lastly there can be a tonsillitis or pharyngitis, or even a problem in the cervical column which triggers the pain to refer into the ear.

In most cases a thorough and proper clinical examination will be sufficient to establish the diagnosis; and the problem causing this pain can then adequately be dealt with.

©Dr. Rik HEYMANS.

 

Health251

 

Is it bad to sleep near your Smartphone?

IF YOU’RE ANYTHING like the average mobile phone owner, you probably sleep with your smartphone within arm’s reach. A recent report has found that 71% of people sleep with or near their phones ,  and that includes the 13% who said they slept with their phones in their beds.

Maybe you’ve wondered whether keeping your phone nearby is a bad idea ,  perhaps it’s zapping your brain with radio waves or otherwise harming your health. It would be comforting if researchers firmly and finally quashed any notions that our devices can cause negative health effects. No such luck.

In November 2018, the U.S. government’s National Toxicology Program wrapped up a 10-year, $30 million study on the health effects of cellphone radiation exposure. In essence, the government scientists blasted rats with different levels of radio frequency radiation (RFR) for varying lengths of time and then watched to see what would happen.

“Our studies showed that radio frequency radiation at the frequencies and modulations used in cellular telecommunications and under the exposure conditions we used can produce adverse biological effects,” says John Bucher, one of the study’s authors and a senior scientist with the National Institute of Environmental Health Sciences. Specifically, Bucher’s study found “clear evidence” of tumours in the hearts of male rats exposed to RFR, as well as “some evidence” of tumours in the brains and adrenal glands of male rats. They found “equivocal” evidence of adverse effects in female rats, meaning it wasn’t clear if the tumours that turned up were caused by RFR exposure.

What to make of these findings? Depends on who you ask.

Bucher says his study was never intended to be the final word on the issue of cellphone radiation and human health. “We’re using this to put together follow-up research programs,” he says.

Even so, Bucher says there may be some “low” risk when a phone is held against the head or body ,  like if you’re on a call or keeping the phone in your pocket while using some kind of hands-free setup. He says these risks could go up with “prolonged and persistent use,” though at this point, defining each of these terms is guesswork.

“If there is a risk, I think it’s minimal,” says Larry Junck, MD, a neuro-oncologist and professor of neurology at the University of Michigan. “We haven’t seen an increase in brain tumours since mobile phone use has become widespread.” Moreover, Junck says the research showing any mechanistic link between cellphone radiation and brain tumours is inconsistent and “methodologically flawed.”

Others look at the existing research with great concern. “I think there’s compelling evidence that electromagnetic radiation exposure is indeed harmful,” says Joel Moskowitz, director of the Center for Family and Community Health at the University of California, Berkeley. He reels off the findings of a dozen recent studies, including a 2017 review from China that found heavy mobile phone users were at significantly increased risk of glioma ,  a type of malignant tumour in the brain and spinal cord.

A 2018 U.K. study found rates of glioblastoma , another cancerous brain tumor ,  more than doubled in England between 1995 and 2015. Specifically, frontal and temporal lobe tumors ,  locations that correspond with where we rest our phones during calls , showed some of the steepest increases. In a follow-up letter to the journal’s editor, the authors of that U.K. study say they looked closely at the U.S. data on glioblastoma rates. After adjusting for post-2000 population changes , changes they say are not factored into the U.S. Central Brain Tumour Registry and other databases that track tumours ,  they turned up glioblastoma increases similar to the ones they tracked in England.

Brain tumours aren’t the only worry for cellphone users. “If you look at modern smartphones, the antennas are in the corners ,  both upper and lower,” Moskowitz says. But the bulk of the cellular signal is now directed down through the lower antennas, “which would make the most significant exposures in the neck area,” he says. He mentions tumours of the neck and thyroid as particularly concerning. And there again, some data suggest rates are rising. Rates of thyroid cancer have tripled in the past three decades and are increasing more rapidly than any other type of cancer, according to the American Cancer Society (ACS).

But none of these findings constitute proof that cellphones are to blame. For example, the ACS says the increased use of tumour-detecting thyroid ultrasounds could explain the uptick in rates of those cancers.

“If there is a risk, I think it’s minimal.”

Why is it so hard to pin down the potential health effects of our devices? One gigantic hurdle is that the technologies these devices employ are constantly evolving, and the research on their health effects is often running a decade or two behind. “Most of the epidemiological studies looking at brain tumour risk collected data in the early to mid-2000s from users who used the old candy bar or flip phones, which were primarily using 1G or 2G cellular technology,” Moskowitz says.

Meanwhile, the telecom industry is now moving forward with 5G technologies, even though health experts still hardly have any data on 4G, he says.

Since this might keep you up at night, let’s get back to the question of sleeping next to your phone. Moskowitz says tumour risks don’t top his list of concerns, because a sleeper’s phone isn’t steadily transmitting the way it does during a call. But he says it’s likely that low-level night time radiation exposures could disrupt sleep and cause other neurological effects.

He points to a small 2016 study from Germany that found exposing men to cellphone radiation seemed to change the structure of their sleep ,  increasing or decreasing REM and other sleep parameters ,  though the health ramifications of these shifts aren’t clear.

Whatever risks may exist could be heightened in kids. “I personally believe that children should be dissuaded from sleeping with a phone under their pillow, as RFR is thought to penetrate farther into their tissues than in adults,” Bucher says.

The obvious advice is to keep your phone out of the bedroom. Or, if you use it as an alarm clock, you could switch it into airplane mode, which stops it from sending or receiving signals, Moskowitz says. He also repeats the longstanding advice to use a wired hands-free device when making calls and to keep your phone away from your body.

Start with all that and hope that the cellphone-radiation Pollyannas turn out to be right.

 

 

Pneumonia...

Pneumonia refers to an infection of the lung tissue. Which often follows a common cold or influenza (hence the importance of vaccination!) and is can be a cause of death,especially in elderly people, or in patients with a depressed immunity or concomitant ilnesses.

Several types of pneumonia exist, and the so-called ‘Legionnaires’ disease’ is just one of them, and perhaps the best known one.

How are they classified?

Several ways of classifying the different types of pneumonia exist.

Depending either on the site, localisation of the pneumonia inside the lung, or depending on the causative organism, bacteria, virus, fungus, or any other kind of micro-organism. Chemical products also can cause a pneumonia, as well as radiation, foreign bodies in the bronchi, or a lung embolism.

Usually pneumonias are classified according to the organism, causing it, bacterial, viral...

How do they present?

A typical bacterial pneumonia will - usually - present with the following symptoms:

Sudden onset of a high fever, or cold chills, and a general feeling of weakness, malaise.

Coughing, accompanied with shortness of breath. Typical especially in children is the ‘flaring nostrils’, where the patient struggles to get air into the lungs.

Often this appears together with a cold sore, or follows a middle ear infection, common cold or a bout of influenza.

Pain is often felt over the ribcage on deep inhalation over the site of the pneumonia, however, especially in children, this pain can sometimes radiate to the abdomen.

Cough is usually producing dark sputum, quite often mixed with blood.

It is important to realise that, besides the typical pneumonias, also atypical pneumonias exist, which present differently, i.e. atypical from the normal pneumonias.

Here the presenting features will be:

Usually a gradual onset,with slow worsening of the symptoms.

Headaches, general body pains and a slight fever are often the first symptoms

Cough is not productive in the majority of cases, with little or no sputum.

Who is at risk?

In fact, anyone can contract a pneumonia, from neonates upwards.

But in normal, healthy people the own immunity is strong enough to fend off the invading bacteria or viruses.

Thus, the people most at risk to get a pneumonia are...

Patients with damaged lungs, for instance: smokers, asthmatics, patients who had TB or radiotherapy of the lungs.

Immunnodepressed patients, patients with cancer or under cancer treatment, AIDS-patients, Diabetics, Alcoholics, patients taking severe anti-rheumatic drugs.

The elderly, in general, fall under this category, since they don’t have such a strong defense against invading diseases anymore.

Are pneumonias curable?

With the wide range of available drugs, and specially antibiotics, most forms of pneumonia can effectively be treated nowadays. It is very important to recognise the symptoms as early as possible, and not to let the disease do too much damage.

Better still is to avoid it, if possible of course, by getting your influenza- immunisation if you are over 60-65 years of age, or fall under one of the risk-categories. Also, by protecting you from the cold and exposure to damp, chilly weather. And, very important, by treating other infections - even as trivial as an ear infection - adequately and promptly.

© Dr Rik HEYMANS

 

Rick218