“Snot is the bread of an otolaryngologist”: an interview with ENT doctor Evgeny Stepanovich

Evgeny Stepanovich has been working as an otorhinolaryngologist for 7 years. In his practice, he faced a variety of diseases. We asked him to talk about professional difficulties and learned a lot of useful information that will help maintain the health of the ears, throat and nose. For example, is hearing loss always detectable? Is it dangerous to remove tonsils? Why is rhinoplasty scary? You will find answers to all these questions in the article.

About the profession

- What do lores do?

- Modern "ear-throat" is quite an interesting and deep discipline. There are otolaryngologists who help singers regain their voice, perform complex microsurgical operations on the ear, and operate on brain tumors through the nose.

What ENT disease do patients most often treat with? What time of year?

- The most popular disease that any outpatient otolaryngologist faces is called snot. This is the bread of an otolaryngologist.

The reasons for their occurrence are different. Someone suffers from chronic sinusitis due to unsuccessful dental treatment, someone runny nose is the result of anatomical defects - for example, a pronounced curvature nasal septum. But most often, patients come with the so-called catarrhal snot - a complex of diseases of the upper respiratory tract.

As a rule, this happens from autumn to spring - when children go to schools and kindergartens, exchange microflora with others.

But in general, different otolaryngological diseases have their own seasonality. There are, for example, seasonal allergic rhinitis - people get sick with them in the spring and summer, during the flowering period of all kinds of plants.

There is otitis externa - inflammation of the skin of the external auditory canal. Often this disease affects those who bathe in open water in the summer.

- Could you remember the most difficult case from practice?

- It will not be easy to remember any specific one. Probably the most difficult thing to work with is when the patient is dealing with a disease that at first glance does not look like something complicated and does not require special treatment. But in reality it turns out that this is a disguised serious illness.

I wanted to treat a sore throat, but in the end I went to an oncologist with a malignant tumor in the throat.

Sometimes it happens like this: the baby's parents think that the child often has stomatitis because he puts dirty toys in his mouth. And then it turns out that the cause of everything is a complex immune disease. The work of an otolaryngologist is often associated with interesting complicated cases.

- What can happen if ENT diseases are not treated?

“It all depends on what we are talking about. Some diseases require almost no treatment. For example, if ARVI occurs in a mild form and is not accompanied by complications, then we should not take either antiviral drugs or immunostimulants. It is only necessary to carefully include symptomatic therapy. Not to “not start” the disease, but to feel comfortable.

For example, if against the background of SARS I have heatI'll take an antipyretic pill. If your nose is stuffy, a vasoconstrictor spray will help. If there is a dry cough, I will start drinking water more actively so that I have more fluid in the body and the sputum becomes less thick.

But there are diseases that need to be treated without fail. If we suspect a patient has a malignant formation of any organ, then the patient's prognosis depends on the timing of the start of treatment - whether he will survive or not.

How to prevent ENT diseases?

- There is a very good way not to get sick - just not to live. Otherwise, you will have to face it.

The only thing I would warn against is overly active self-treatment. Especially if you do not have enough experience or understanding of the issue.

For example, if you have a sore throat for a long time and you gargle it with aviation kerosene on the advice of a neighbor, it will only get worse. In the end, you still end up with a doctor. But he will have to deal not only with the original disease, which you may have come with initially, but also with its advanced form and complications.

Treatment in this case may take longer. Therefore, it is always best to consult a doctor first.

- Are chronic tonsillitis, sinusitis and other diseases treatable?

Some, yes, but not all. For example, under the term "chronic tonsillitis» A fairly large number of different conditions of the palatine tonsils fall. If a person is constantly faced with paratonsillar abscesses, if due to inflammatory foci in the pharynx, other organs and systems of the body suffer from it, then he needs surgical intervention - removal tonsils.

There is another situation. For some people diagnosed with chronic tonsillitis, the quality of life does not suffer. They are not bothered by pain in the joints, they do not have any abscesses in the tonsils. Yes, sometimes there is bad breath and a feeling of a foreign body in the throat. But here it is enough just to carry out cosmetic procedures - to clean, wash the tonsils, and the person will begin to feel better. The effect will last for a year.

It happens that certain chronic conditions go into spontaneous remission on their own - for example, against the background of hormonal changes after pregnancy, childbirth or the end of breastfeeding.

Or due to the fact that a person began to treat his lifestyle differently: he quit smoking, began to observe daily routine, get enough sleep, eat on time, engage in moderate physical activity, walk on fresh air. Thanks to all this, his body will be better able to resist chronic foci of inflammation.

— What stereotypical judgments do you most often encounter in your work?

There is a popular stereotype that green snot is bad, but transparent is good. Parents of little patients often come to us and say: “At first everything was fine, and then green snot appeared. Apparently a bacterial infection. We need to urgently start drinking antibiotics!”

In fact, the stage of "green snot", or rather mucopurulent discharge, is a natural stage in the course of a respiratory viral infection. In this situation, the color is not yet a reason to prescribe antibiotic therapy. For this, completely different criteria are evaluated: the results of an objective examination, the nature and duration of the disease.

About ear health

- There is an opinion that hearing problems are always obvious. Is this true?

- Not always. In particular, when we, for example, talk about congenital sensorineural hearing loss. In this case, the person is already born with hearing loss. Naturally, the baby cannot be asked if he hears well.

But we know: the sooner we diagnose the problem, the sooner we will help the child. For example, we will prosthetize it - we will give the opportunity to hear with the help of special equipment.

For this, the so-called neonatal audiological screening is carried out. Almost every maternity hospital newborn undergoes an examination using a special device that diagnoses hearing problems.

In adulthood, it is easier to track the state of your hearing. We will notice if it sharply, quickly or smoothly begins to decline. It happens differently for everyone: someone’s ear suddenly stuffed up and all sounds disappeared, and someone noticed that the speech of loved ones gradually became less intelligible for him.

What are the reasons for this hearing loss?

- A lot of them. It all depends on which department is affected. There are three of them: outer, middle and inner ear.

1. Outer ear. Here it may form sulfur plug. It will simply caulk the lumen of the sound channel, and the sound wave will not pass further - to the middle and inner ear. The person will experience hearing loss.

Sulfur plug is my favorite disease. Came, you removed it. You recovered instantly. And the doctor is happy that he helped, and you are glad that you hear again.

2. Middle ear. Diseases are characterized by the fact that the external auditory canal is free, the sound wave passes unhindered to the eardrum, and then, to the auditory receptor, with difficulty. Sometimes these changes are temporary and are a complication of a cold sore. But in some cases, this may mean the presence of a chronic pathology of the middle ear. For example, such as chronic purulent medium otitis.

In such a situation, it is necessary to perform a surgical operation: to form a new eardrum, remove the affected tissues from the middle ear, and prosthetize part of the destroyed structures. Then the person will again begin to hear well.

3. Inner ear. It is part of the nervous system, the auditory receptor. Problems can arise when a person has taken a drug, one of the side effects of which is the risk of hearing loss. Due to its ototoxicity, this substance destroyed part of the auditory receptor cells.

Or another option: a person increased blood pressure, narrowed the lumen of the vessels that feed the inner ear. And part of the auditory receptor cells suffered from a lack of blood flow. In both cases, hearing declined.

- What is hearing loss? Can we reverse it?

- There are diseases that by themselves or with untimely diagnosis can no longer be cured. Medical options are limited. But this does not mean that a person cannot be helped.

We can, for example, suggest wearing a hearing aid. It amplifies certain sound frequencies, and the person regains the ability to communicate normally.

Why can't you use cotton swabs to clean your ears?

- All modern clinical recommendations are against the use of cotton buds. This can injure the skin of the external auditory canal or eardrum, push sulfur into the deep sections auditory canaland help spread the infection. I know that it is very difficult to get rid of this bad habit. Therefore, cotton buds sell well.

What else is dangerous for our ears?

- Harsh loud noise impacts. Therefore, law enforcement officers or the military at the firing range are recommended to use special noise-canceling equipment - headphones, which will protect their auditory nerves.

This is also the case for train drivers. The metro has a very active vibration and noise load. With regular prolonged exposure, it can lead to hearing loss.

What about listening to music with headphones? Can it also lead to hearing loss?

- I have not seen a study that would show any clear criteria - for example, that you can use headphones for an hour and a half a day. However, you need to understand: if you spend 10 hours a day in them and listen to music loudly, then you will not be much different from an electric train driver.

Modern technology helps prevent hearing loss against this background. She is smart enough to warn us when we turn up the volume too much.

About throat health

Why do your patients most often have sore throats?

- Most often, the cause is infectious diseases of the pharynx. They can be of three types: viral, bacterial and fungal. Also acute or chronic.

Sometimes the throat hurts for other reasons. For example, someone has trouble breathing through their nose. In sleep, he has to open his mouth to take in oxygen. In this case, the air enters the respiratory tract unheated and unmoistened. The pharynx dries up, and this leads to severe pain in the throat.

Or, for example, when expressed heartburn reflux of gastric contents back into the esophagus. From there, this acid enters the respiratory tract, irritating the mucous membrane of the pharynx, which also leads to a sore throat.

- There is an opinion that the professional disease of teachers is laryngitis. Can it really arise because a person talks a lot?

- Laryngitis is an inflammation of the larynx, one of the functions of which is voice formation. Of course, yes. With an active vocal load, the vocal apparatus can wear out quite quickly, and a person will have problems.

There are many such patients among specialists in vocal professions. Basically, phoniatrists work with them - ENT doctors who treat only the larynx.

But if teachers, teachers, teachers, educators have voice problems, then they also need help and teachers who can correctly deliver the voice so that frequent workload does not overstrain the voice apparatus.

As singers study with vocal teachers, so people of voice professions can receive special staging lessons vote.

- What folk methods for treating the throat work, and which ones do not?

- There is one method that always works - a plentiful warm drink. It is already so popular that it is in service with all medicine. The liquid will moisten the mucous membrane of the throat, and the throat will most likely feel better. This does not mean that you will necessarily recover faster, but the course of the disease will be alleviated.

The benefits of rinsing are clearly exaggerated: not all throat diseases require them. But, as a rule, it works as a moisturizer. Unless, of course, you use not some aggressive means such as kerosene, but an ordinary salt solution with soda.

However, here one must understand that some procedures also have a psychotherapeutic effect: “I do not just idly drink tea, but rinse throat saline solution - I carry out a medical procedure, and this makes me feel better. Sometimes it works like that.

But instead of gargling six times a day, you can drink sweet tea occasionally and it will make you feel just as good.

In general, with regard to folk methods: when we talk about the effectiveness and safety of a method of treatment or a drug, we must rely on something. In today's world, you need to back up your opinion with the results of complex, double-blind, placebo-controlled, randomized trials.

And many folk methods do not pass such a test. We cannot say that any method will definitely hurt, but at the same time we cannot say that it will make it easier and that it is really safe.

Therefore, if you decide to be treated, then even folk methods, I would advise you to discuss with your doctor. Do not be afraid to ask him stupid questions in your opinion. You may receive important timely information.

- Many people are afraid to remove their tonsils, because this will allegedly reduce immunity. Is this fear justified?

- Firstly, the phrase "decreased immunity" has discredited itself. It is difficult to describe in two words the whole complex set of systems that protect our body from the influence of pathogenic agents.

Secondly, I want to remind you that in the human body there is a vermiform appendix, which is located in the intestine and also consists of lymphoid tissue, - appendix. It also protects our body. But do we need to delete it just like that? Of course not.

However, if he suddenly falls ill, ceases to perform his functions, and even becomes dangerous for the body, then, of course, the person will undergo an operation. With palatine tonsils - a similar story. It's just that things don't develop so quickly and urgently.

There are certain indications for their removal:

• a person takes 6-8 courses antibiotics per year to suppress the focus of inflammation;
• his quality of life is reduced - for example, he cannot afford to eat ice cream or drink a glass of cool milk;
• due to inflammation in the palatine tonsils, other tissues and organs are affected;
• joints hurt.

Yes, after the operation to remove the palatine tonsils, a person may face complications. But in this situation, we weigh the benefits and hypothetical harm. In adults, this organ no longer has such an important immune function as in children. You can safely part with tonsils, if there is evidence for that.

About the health of the nose

- How to blow your nose?

- The instruction looks like this:

1. If you want to blow your nose, then you need to close one half of it, and leave the other free, so as not to accidentally drive this mucus into your ear.
2. When blowing, you can open your mouth slightly so that increased pressure in the nasopharynx is not created and discharge from the nose does not get into the ear.

Is it dangerous to make a puncture with sinusitis?

- What is popularly called a “puncture”, in our beautiful medical language is called a puncture of the maxillary sinus. This is one of the most popular methods of treatment in Russia for acute sinusitis - inflammation of one of the paranasal sinuses.

The puncture looks like this: we puncture the sinus through the nasal cavity, pump out pus from there, and wash the hole. Sometimes we introduce drugs there.

There is a popular myth: if you made a puncture once, now you will do it all the time. Indeed, there are patients who have to regularly perform punctures of the paranasal sinuses. But this is not due to the fact that a person was “pierced”, but because his sinusitis is chronic and is sometimes accompanied by exacerbations.

Such a patient should be carefully examined in search of the cause of chronic inflammation of the maxillary sinus.

It happens that he has a deviated nasal septum. This affects the entry of air into the paranasal sinuses. In such a situation, plastic surgery is necessary to ensure normal ventilation of the nose.

For someone, the cause of chronic inflammation may be a filling material that has fallen into the paranasal sinus. Then this foreign object needs to be removed as soon as possible, and it will be possible to completely forget about sinusitis. In general, you should not be afraid of "punctures".

But remember that in modern conditions it is not necessary to puncture the affected sinus. Most often, it is enough to choose the right treatment. Discuss this with your doctor.

- You touched on the topic of rhinoplasty. Are there cases when it worsens the condition of the nose?

- Many people confuse two operations with a similar name: septoplasty and rhinoplasty. When we talk about the latter, we are pursuing an aesthetic goal - changing the shape of the nose.

Septoplasty is aimed at changing the shape of the nasal septum, if its curvature affects the quality of life of a person. During this operation, we change everything only inside the nose so that it breathes normally.

And there is rhinoseptoplasty - an operation aimed at simultaneously changing the shape and septum of the nose. In this case, we achieve both aesthetic and functional goals.

- Can rhinoplasty worsen the state of health?

Any surgical intervention is a risk. Often this is not because the surgeon worked carelessly. Most often, problems arise when the patient does not follow the instructions received from the doctor for self-care in the postoperative period.

— What can you say about nose piercing as an otolaryngologist?

- Complications piercing possible, as in any violation of the integrity of the tissue. But they are not lethal. If you decide to decorate your body in this way, choose a trusted master who works in a licensed beauty salon, sterilizes all instruments and uses quality materials. It is better to overpay, but reduce the risk of complications.