Each week in the United States, approximately 150,000 cerumen removals take place. Otologic complications include pain, perforated tympanum, dizziness, bleeding and infection. The prevention and management of such complications are discussed below. Accepted methods of removal should be used and all perforations and other forms of trauma, when they occur, must be evaluated for middle and inner ear pathology. Handicapped patients and those under custodial care represent a group that is underserved at this time. Possible solutions are discussed.
Mucociliary Clearance can be measured clinically with the Saccharine Test in the sino-nasal system. When clearance is slow, treat mucus viscosity and slow ciliary beat frequency. Chronic sinusitis and bronchitis are often due to poor MCC. Therapy to upper or lower respiratory system benefits both.Therapy for Mucociliary Clearance includes proteolytic enzymes to reduce mucus viscosity, vibrations for improving ciliary beat frequency, irrigation with Locke-Ringer's solution for cilia frequency, glucosteroids and surfactants.
our patient's history is that she had some difficulty breathing at night. The doctor diagnosed a deviated septum and recommended correcting it. She is seeing you now because 3 months after surgery, she isn't getting enough air! She says she can't breathe! You check her oxygen level and it is 99%. You look into her nose and the septum is perfectly straight! In addition, there is more than enough room for air passage. Why is this patient complaining of not getting enough air? Does she have Empty Nose Syndrome (ENS) [1]? Eugene Kern, M.D. had such a patient. When he took a CT of the sinuses, he saw that the inferior nasal turbinates had been removed. Even the middle turbinates were smaller. His student remarked that the nose looked empty-hence the name Empty Nose Syndrome or ENS [2].
to the stomach where acid detoxifies the bacteria [1]. If the MCC is slowed, then bacteria remain in place, and multiply. If MCC is slowed, then mucus accumulates, and thickens. This further slows cilia movement. If the mucus thickens, this inhabits Cilia Beat Frequency (CBF) [2]. Cilia are in a lower layer that is thin. The upper layer-the gel layer contains goblet cells, submucosal glands, mucin, IgA, albumin, lactoferrin and lysozyme. Normally between 1-2 liters of mucus are produced daily. Synchronous movement of the cilia moves the upper gel layer. Aids to CBF β-agonists, including salmeterol and salbutamol, raise intracellular cAMP levels and thereby increase cilia beat frequency.
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