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LNASAL Avades, breathe without obstacles
The obstruction of the nose is a very common problem that hinders the action of breathing and is the reason why many people, of any age, suffer periodic discomfort and even chronically. Like other vital functions, breathing occurs automatically, and under normal conditions we are not aware of it until something stops the free passage of air.
It can have multiple causes, from a simple cold to dryness or environmental pollution, and one of the best ways to clear the nose and maintain adequate humidity, hygiene and respiratory quality are nasal washes through physiological solutions of water from sea.
There is a broad scientific consensus on the benefits of nasal washes. With a correct use, nasal washes also lack unwanted effects, so, as Dr. Joan Montserrat i Gili, clinical chief of the Orl Service Rhinology section of the Sant Pau Hospital, in Barcelona , "There is no age limitation for nasal washing". In the baby and in the elderly, the nasal washes provide an added benefit, in some of the immunity of their immune and respiratory apparatus, and in others by the problems that lead to the deterioration of tissues due to aging.
The nasal mucosa forms a protective barrier of our respiratory tract and is exposed to infections and the aggression of numerous harmful agents that float in the environment. The common cold, influenza or allergies are often frequently behind the inflammation of the nasal mucosa and consequent excess in the production of mucus that prevents us from breathing normally.
Other times, nasal obstruction is due to the suffering of certain pathologies that affect respiratory function and treatment with certain drugs, such as corticosteroids, which favor dryness of the nose, or it can reach as a consequence of an intervention Surgical because of trauma, for the correction of the nasal septum or for the extraction of polyps.
As Dr. Joan Montserrat explains, "Nasal washing is indicated in normal hygiene of the nose, in rhinitis of any kind, both that produces typical rhinorrhea or excess mucus such as dry rhinitis, situations that They produce nasal dryness either with or without scab formation, and provided that there is a postoperative cure because a nasal surgery or paranas sinuses has been carried out. "
For this, the physiological solutions of sea water, in addition to the hygiene of the nose, favor the hydration of the mucosa through the absorption of minerals and oligoelements of the marine plankton.
The paranasal sinuses are cavities that serve to condition the temperature and humidity of the air we breathe before it passes into the interior. These sinus cavities are equally coated by mucous and communicated with the nostrils, with which they form a unit. There is talk of nasosinusal or rhinosinusitis infections when the whole set is affected.
If the nasal mucosa is a first line of struggle to stop the entrance of germs, irritating products and dirt towards the lungs, it is easily understood the importance of keeping those tissues in the best conditions so that they can fulfill their task. In this sense, nasal washes have demonstrated their usefulness not only to alleviate nasal congestion by mechanical dragging of excess moisture and harmful particles trapped in the mucus, but also as a good preventive method for those who have incorporated them to their Daily hygienic routine.
To apply nasal washes classically have been using systems such as rubber pear or syringe, which today seems to be a thing of the past compared to the devices currently available that facilitate the correct application of the washes.
damage the delicate internal structure of the nose, either by an involuntary rubbing or by applying excessive pressure with the syringe, it is a risk that is avoided with the use of modern devices that perform nasal washing by microdifusion, have Of a nozzles adapted to the anatomy of the child's nose and the adult, and both the dose and the pressure are controlled in each application. This facilitates the task with children (also with some elders) that are little willing to collaborate.
Sea water and physiological serum
Two types of solutions for nasal washing are used. The classic is the séum or physiological serum, which is a 0.9% solution of sodium chloride in sterile water. Currently the nasal washing can be done with a natural product such as sea water, which is also a solution with 0.9% salt and is obtained directly from the sea by filtration, with an interesting difference with respect to serum: sea water It preserves the trace elements and minerals that are present in the marine waters, and it has been seen that they provide benefits to the nasal mucosa.
In the opinion of Dr. Joan Montserrat, "the sea waters, with respect to the Sérum, incorporate a series of trace elements that have a demonstrated capacity as local anti-inflammatories. It is evident that the patient with any type of rhinitis, both that produces an excess of mucus and dry rhinitis, always improve with sea water not only because of the cleaning capacity but also by the intrinsic properties of the trace elements. "< / p >.
For pharmaceutical use, sea water is obtained directly by filtration at certain locations and is enriched with trace elements (very small amounts) of the marine environment, such as copper, with anti-inflammatory capacity and against the proliferation of bacteria; the manganese, which has an anti-allergic effect; La Plata, with an antiiseptic effect; potassium; Calcium and others.
The physiological serum is presented in large containers, with the risk of contamination by the successive extractions with syringe or dropper, and in a single-use blisters. Sea waters can be found in spray, with different presentations according to their use and age. They have anatomically adapted nozzles, with a soft safety stop for babies and small children, and allow the application of a predetermined amount at a controlled pressure.
As for pregnant women and / or breastfeeding, there is no contraindication; On the contrary, its use in pregnant women should be encouraged to alleviate frequent nasal congestion states due to hormonal or gestational rhinitis.
Dr. Joan Montserrat recommends that they usually be used at low pressure, since applying excessive pressure could irritate the mucosa, but applying a significant volume.
It is recommended to use sea waters at low pressure whose administration system is by microdiFusion (thin spray) and not by jet.
For large congestions, there is a hypertonic water presentation, with a higher concentration of sodium chloride, which has a greater capacity of decongestion thanks to a natural process of osmosis.
In cases of rhinosinusitis and allergic rhinitis, there is physiological sea water solution with manganese, which, as we already mention, has an added anti-allergy effect.
Rocopathy: The enemy in the bedroom
The snoring are among the most annoying experiences that a large percentage of the population has to suffer daily. Chronic roncopathy, as medically defined to the habit of snoring, is not more important from the health point of view if it is simple snoring; However, they worsen the quality of the sleep of the snack.
Rincopathy is produced by a clogging of the respiratory path during sleep, which is a consequence of bad nasal ventilation and an elongated palate, fallen and flaccid. When breathing there is no suitable passage of air, so the palate collapses and, depending on the pressure that the air exerts on the throat walls to enter the pharynx, a vibration that results in characteristic sound is produced That we all identify as snoring.
To sleep we need our organism to enter a state of relaxation that it keeps vital functions in automatic mode, such as cardiac pulse and breathing. During sleep they also relax the muscles of the pharynx and decrease their diameter, which represents an added challenge for people who have a narrow pharynage or any other alteration of the upper respiratory path, such as vegetations, nasal partition deviation or increased increase Size of the tonsils. Due to the obstruction, the person will try to breathe opening his mouth, with which the mucosa is dry that protects his throat. Also, if the snoring sleeps face up, the tongue falls back, so that one after the factors that lead to snoring are chained.
There are two types of snacks, as explained by Dr. Carlos Carlada Carvedo, head of the otolaryngology unit of the Madrid Institute of ORL (Imorl), at the San Francisco de Asís Hospital. "On the one hand, the simple snoring, which is the person when when sleeping produces a sonority that we recognize as the typical snoring. On the other hand, the snack with sleep apnea. The vast majority of people who snore have no sleep apnea, but almost all of those who have sleep apnea are snacks ».
Dr. Mercadal clarifies the following: "Everyone has apneas during sleep, which are small interruptions of breathing without alteration of oxygen saturation in the blood; It is normal to present approximately 5 apneas per hour. However, when a person presents more than 10 apnees per hour, it is considered to have a pathology that we define as sleep apnea, which produces an interruption in the supply of oxygen to tissues. "
Chronic roncopathy is more frequent in men, but as age increases, this balance is balanced with women, particularly those that after menopause increase their weight. Normally, the relationship of man / woman snoring is usually 2: 1. It is also a problem that affects children, most of the time simply related to obstructive disorders of rhinopharynx, an increased size of nasal slopes or, to a greater extent, the presence of adenoid tissue (vegetations) and hypertrophy of tonsils.
Dr. Mercadal, as an expert in this type of disorders, explains that the diagnosis of roncopathy is carried out by "carrying out a study other than that is done for sleep apnea syndrome. Thanks to that study of snoring we can observe when and with what intensity a patient is; The average is obtained, the maximums and the minimum decibels, as well as their relationship with the position that that person adopts when Renca. Most hoarse more intensity when they are in a supine position (face up) ".
Obesity has a very direct relationship with roncopathy, although there are also thin people who snore. When an obese person loses weight, the problem decreases and can even stop snoring. The fat tends to accumulate in the submucosal lateral walls of the pharynx and the palate, so that when fat is lost, the space for air transit increases.
Dr. Mercadal explains that there are a series of "tricks" to attenuate the problem of snoring. You have to avoid the use of large pillows or 2 at a time, as they force sleeping by excessing the cervical spine. That gesture throws back the base of the tongue and compresses the larynx, which facilitates snoring. The non-thick pillows are recommended.
It is also important that the person who snores try to sleep on the side, instead of face up, helping himself if it is necessary some kind of wedge to prevent him from turning while he sleeps.
In addition, the general recommendations on the factors that favor roncopathy, such as overweight and the consumption of toxic and irritating substances (eg, alcohol and tobacco).
Tonsillitis: viral or bacterial?
The tonsils are lymphatic structures that are part of the body's defense system and are responsible for manufacturing specialized cells, lymphocytes, which help us detect and eliminate, by creating antibodies, a great variety of microorganisms capable of Provoke infections.
Palatine tonsils, also vulgarly called angels, are part, together with lingual and pharyngeal (adenoid) tonsil, of a major defensive structure, which is called the Waldeyer Ring, and are located in an unbeatable place to exercise its mission Protective, the throat, just at the end of the mouth and nose, at the entrance of the respiratory tract.
Usually, when talking about tonsils are referenced to palatinas tonsils, which are located at the bottom of the oral cavity, one on each side of the uvula, or bell.
Tonsillitis is the inflammation of this tissue, caused by virus infections or bacteria. In medical language, the terms "tonsillitis", "pharyngitis" and "pharyngoamigdalitis" are used to refer to the same process, according to the involvement of amazing tissue and / or the surrounding pharyngeal mucosa.
Acute pharyngoam cellitis is caused, in almost 80% of cases, by several types of viruses, and the remaining 20% has a bacterial origin, in which the most frequent bacteria is the bethemolytic streptococcus of Group A. In addition, A viral infection is always capable of complicating with bacterial overinfection.
The disease can affect both children and adults, although it is very frequent in pediatric age. In children under 3 years, the main causal agents of infections are usually virus, while acute bacterial tonsilitis is the most frequent bacterial infection in children and adolescents of 3-15 years, and has its peak of maximum incidence among the 5 and 10 years.
Viral origin pharyngoam cellitis has a slower and slower start; After an incubation of about 3 days, the symptoms begin abruptly, and the processed pharyngia is accompanied by other catarrier symptoms, such as cough, low fever, muscle aches, increased nasal mucus, conjunctivitis and diarrhea. These conditions tend to take by epidemics and are very contagious.
Bacterial pharyngoamalitis manifests the symptoms more abruptly; There are no cough, but sore throat can be very intense, especially when swallowing, fever goes up above 38K, there are inflamed and painful lymph nodes under the jaw and neck, and tonsils are flushed or can present stains White with the formation of purulent plates. It can also cause cephalet and a reflex pain in the ear, abdominal pain and nausea. They usually have less epidemic character and are less contagious than virals.
When the trigger is a virus, it is necessary to monitor the natural evolution of the disease, usually 1 week, and try to alleviate symptoms with antipyretics, analgesics or other specific medicines for throat or respiratory discomfort; In addition, it is recommended to drink cold liquids or gargle with warm salt water. Only in cases where the bacterial presence is suspected, the doctor will add the prescription of an antibiotic treatment.
Diagnosis
To make the diagnosis, the physician has the data in the clinical history and a careful physical examination. In addition, as explained by Dr. Javier González de Dios, head of the Pediatric Service of the University Hospital of Alicante, "Today we have rapid tests to detect streptococcus, at Emergency AT services or in consultations, which in a matter of minutes allow Advance the diagnosis against cultivation, which takes a few days. Clinical manifestations sometimes do not allow to differentiate with certainty between viral and bacterial pharyngoamalitis, although it is approaching the diagnosis. For this, we use the scale of MCISAAC, which gives a score according to the symptoms and the age of the patient. If it meets 3 or more criteria on this scale, it is very likely that it has the streptococcus, then we do the rapid detection test and, if it gives positive, we apply antibiotic treatment ».
The diagnostic efficacy of the Rapid Test of Detectococcus of Group A has been confirmed at a recent meta-analysis, published in the prestigious Scientific Journal Pediatrics, which encompasses the result of 48 studies carried out on this topic in 24,000 patients. The conclusions indicate that the rapid test for the detection of streptococcus has a sensitivity of 86% and a specificity of 96%.
In the opinion of Dr. González de Dios, "this specificity makes the degree of certainty of a positive result of the test is very high, that is, that the patient who gives positive really has the group A and, by Both, we should apply the timely antibiotic, which in this case would be oral amoxicillin. As for the sensitivity of the test, there is a small percentage of cases that would not give positive despite the possible presence of the bacteria. With this meta-analysis, the agreement has been reached that in this small percentage of patients, they would give negative in the test although they could have the streptococcus, its evolution should be observed. It should be assumed that little risk of not initially treating, because if the patient continues with a fever and sore throat, he will come back to Emergencies at or the consultation, and at some point the antibiotic will be applied before 10 days, which is The known period for the prevention of non-suppurative complications ».
This expert insists on the need for adequate use of antibiotic treatment in cases that actually need it, never resort to self-medication and fully fulfill the prescribed pattern. In this way, it is avoided to contribute to the increase of bacterial resistance, relapses and the appearance of suppurative complications, such as otitis media, acute sinusitis or the formation of an abscess of pus together with tonsils.
In the opinion of Dr. González de Dios, "the antibiotic in pharyngoamigdalitis offers us the great advantage of avoiding other non-suppurative and latest complications, which can affect the heart, such as rheumatic fever, or causing kidney damage, such as Posttreptococcal glomerulonephritis. Fortunately, these long-term complications are very rare in Spain and in all developed countries in which the use of antibiotics is widespread, because they are complications that arise when streptococcus is not treated with antibiotic. "
tonsilllectomy
Surgical removal of the tonsils was in times past a common practice to treat tonsillitis. At present, according to this expert, "tonsillectomy has two fundamental indications: on the one hand, it still has a very clear indication in children with repetition tonsilitis, applying the classic criterion of at least 5-6 episodes per year during , at least 2 years; On the other hand, it is an essential tool in the obstructive sleep apnea syndrome (SAOS), which affects children who have sleeping snoring associated with frequent breathing breaks (apneas). "
A technique that offers excellent results is the removal by plasma band, or surgical coblation device, which eliminates tissue at the same time as it cauterizes, in a similar way to the laser, but using temperatures many lower that favor a faster healing and Less painful. It can be used in complete amazing removals, as well as in cases of tonsil reductions by SAOS, in which a small portion of tonsil tissue is left that continues to act as a useful defensive tissue.
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