Adenoids Health Dictionary

This is usually attributed to vibrations of the soft PALATE, but there is evidence that the main fault lies in the edge of the posterior pillars of the FAUCES which vibrate noisily. Mouth-breathing is necessary for snoring, but not all mouth-breathers snore. The principal cause is blockage of the nose, such as occurs during the course of the common cold or chronic nasal CATARRH; such blockage also occurs in some cases of deviation of the nasal SEPTUM or nasal polypi (see NOSE, DISORDERS OF). In children, mouth-breathing, with resulting snoring, is often due to enlarged TONSILS and adenoids. A further cause of snoring is loss of tone in the soft palate and surrounding tissues due to smoking, overwork, fatigue, obesity, and general poor health. One in eight people are said to snore regularly. The intensity, or loudness, of snoring is in the range of 40–69 decibels. (Pneumatic drills register between 70 and 90 decibels.) Bouts of snoring sometimes alternate with SLEEP APNOEAS.

Treatment therefore consists of the removal of any of these causes of mouth-breathing that may be present. Should this not succeed in preventing snoring, then measures should be taken to prevent the sufferer from sleeping lying on his or her back, as this is a habit strongly conducive to snoring. Simple measures include sleeping with several pillows, so that the head is raised quite considerably when asleep; alternatively, a small pillow may be put under the nape of the neck. If all these measures fail it may be worth trying the traditional method of sewing a hairbrush, or some other hard object such as a stone, into the back of the snorer’s pyjamas. Thus, if they turn on their back, they are quickly awakened. (See also STERTOR.)... snoring

Surgical removal of the adenoids.

An adenoidectomy is usually performed on a child with abnormally large adenoids that are causing recurrent infections of the middle ear or air sinuses.

The operation may be performed together with tonsillectomy.... adenoidectomy

Inflammation of the middle ear. Usually spreads from the nose or throat via the Eustachian tube. Tonsillitis, sinusitis or ‘adenoids’ predispose. A frequent complication of measles, influenza or other children’s infections. Sometimes due to allergy.

Symptoms. Effusion of fluid into the middle ear with increasing deafness, discharge, tinnitus. Infant shakes head. Perforation in chronic cases. Inspection with the aid of an auriscope reveals bulging of the ear-drum. Feverishness.

Treatment. Antibiotics (herbal or others) do not remove pain therefore a relaxing nervine should be included in a prescription – German Chamomile, Vervain, etc.

Before the doctor comes. Any of the following teas: Boneset, Feverfew, Holy Thistle, Thyme. One heaped teaspoon to each cup boiling water; infuse 15 minutes; one cup thrice daily.

Formula. Practitioner. Echinacea 2; Thyme 1; Hops half; Liquorice quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Acute: every 2 hours. Chronic: thrice daily.

Topical. Dry-mop purulent discharge before applying external agents. Inject warm 2-3 drops any one oil: Mullein, St John’s Wort, Garlic, Lavender or Evening Primrose.

Once every 8-10 days syringe with equal parts warm water and Cider Vinegar. Repeat cycle until condition is relieved.

Diet. Salt-free. Low-starch. Milk-free. Abundance of fruits and raw green salad vegetables. Freshly squeezed fruit juices. Bottled water. No caffeine drinks: coffee, tea or cola.

Supplements. Vitamins A, B-complex, B2, B12, C, E, K, Iron, Zinc. Evening Primrose capsules.

Notes. Where pressure builds up against the drum, incision by a general medical practitioner may be necessary to facilitate discharge of pus. Grossly enlarged tonsils and adenoids may have to be surgically removed in chronic cases where treatment over a reasonable period proves ineffective. A bathing cap is sometimes more acceptable than earplugs.

Breast-feeding. Significantly protects babies from episodes of otitis media. Commenting on a study published in the Obstetrical and Gynaecological Survey, Dr Mark Reynolds, author of a breast-feeding policy by the Mid-Kent Care Trust said: “Breast milk is known to reduce respiratory infection – a precursor of otitis media.”

Hopi ear candles. ... otitis media

Sanguinaria canadensis. N.O. Papaveraceae.

Habitat: Widely distributed throughout North America.

Features ? Root reddish-brown, wrinkled lengthwise, about half-inch thick. Fracture short. Section whitish, with many small, red resin cells which sometimes suffuse the whole. Heavy odour, bitter and harsh to the taste.

Part used ? Root.

Action: Stimulant, tonic, expectorant.

Pulmonary complaints and bronchitis. Should be administered in whooping-cough and croup until emesis occurs. The powdered root is used as a snuff in nasal catarrh, and externally in ringworm and other skin eruptions. The American Thomsonians use it in the treatment of adenoids. Dose, 10 to 20 grains of the powdered root.... blood root

Impairment of hearing, which affects about 2 million adults in the UK. In infants, permanent deafness is much less common: about 1–2 per 1,000. It is essential, however, that deafness is picked up early so that appropriate treatment and support can be given to improve hearing and/or ensure that the child can learn to speak.

In most people, deafness is a result of sensorineural hearing impairment, commonly known as nerve deafness. This means that the abnormality is located in the inner ear (the cochlea), in the auditory nerve, or in the brain itself. The prevalence of this type of hearing impairment rises greatly in elderly people, to the extent that more than 50 per cent of the over-70s have a moderate hearing impairment. In most cases no de?nite cause can be found, but contributory factors include excessive exposure to noise, either at work (e.g. shipyards and steelworks) or at leisure (loud music). Anyone who is exposed to gun?re or explosions is also likely to develop some hearing impairment: service personnel, for example.

Conductive hearing impairment is the other main classi?cation. Here there is an abnormality of the external or middle ear, preventing the normal transmission of sound waves to the inner ear. This is most commonly due to chronic otitis media where there is in?ammation of the middle ear, often with a perforation of the ear drum. It is thought that in the majority of cases this is a sequela of childhood middle-ear disease. Many preschool children suffer temporary hearing loss because of otitis media with e?usion (glue ear). Wax does not interfere with hearing unless it totally obstructs the ear canal or is impacted against the tympanic membrane. (See also EAR; EAR, DISEASES OF.)

Treatment Conductive hearing impairment can, in many cases, be treated by an operation on the middle ear or by the use of a hearing aid. Sensorineural hearing impairments can be treated only with a hearing aid. In the UK, hearing aids are available free on the NHS. Most NHS hearing aids are ear-level hearing aids – that is, they ?t behind the ear with the sound transmitted to the ear via a mould in the external ear. Smaller hearing aids are available which ?t within the ear itself, and people can wear such aids in both ears. The use of certain types of hearing aid may be augmented by ?ttings incorporated into the aid which pick up sound directly from television sets or from telephones, and from wire loop systems in halls, lecture theatres and classrooms. More recently, bone-anchored hearing aids have been developed where the hearing aid is attached directly to the bones of the skull using a titanium screw. This type of hearing aid is particularly useful in children with abnormal or absent ear canals who cannot therefore wear conventional hearing aids. People with hearing impairment should seek audiological or medical advice before purchasing any of the many types of hearing aid available commercially. Those people with a hearing impairment which is so profound (‘stone deaf’) that they cannot be helped by a hearing aid can sometimes now be ?tted with an electrical implant in their inner ear (a cochlear implant).

Congenital hearing loss accounts for a very small proportion of the hearing-impaired population. It is important to detect at an early stage as, if undetected and unaided, it may lead to delayed or absent development of speech. Otitis media with e?usion (glue ear) usually resolves spontaneously, although if it persists, surgical intervention has been the traditional treatment involving insertion of a ventilation tube (see GROMMET) into the ear drum, often combined with removal of the adenoids (see NOSE, DISORDERS OF). Recent studies, however, suggest that in many children these operations may provide only transient relief and make no di?erence to long-term outcome.

Advice and information on deafness and hearing aids may be obtained from the Royal National Institute for Deaf People and other organisations.... deafness

Diseases may affect the EAR alone or as part of a more generalised condition. The disease may affect the outer, middle or inner ear or a combination of these.

Examination of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magni?cation.

Tuning-fork or Rinne tests are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating fork is audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to di?erentiate between conductive and nerve deafness.

Hearing tests are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The intensity of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing, at that frequency, through air and bone respectively. It may be necessary to play a masking noise into the opposite ear to prevent that ear from hearing the tones, enabling each ear to be tested independently.

General symptoms The following are some of the chief symptoms of ear disease: DEAFNESS (see DEAFNESS). EARACHE is most commonly due to acute in?ammation of the middle ear. Perceived pain in this region may be referred from other areas, such as the earache commonly experienced after tonsillectomy (removal of the TONSILS) or that caused by carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause. TINNITUS or ringing in the ear often accompanies deafness, but is sometimes the only symptom of ear disease. Even normal people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. The intensity of the tinnitis usually ?uctuates, sometimes disappearing altogether. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness. The symptom seems to originate in the brain’s subcortical regions, high in the central nervous system. It may be a symptom of general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse, and may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitis, but unfortunately in many cases the noises persist. Management involves psychological techniques and initially an explanation of the mechanism and reassurance that tinnitus does not signify brain disease, or an impending STROKE, may help the person. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.

Diseases of the external ear

WAX (cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitis and sometimes disturbance of balance. Wax can sometimes be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected. FOREIGN BODIES such as peas, beads or buttons may be found in the external ear canal, especially in children who have usually introduced them themselves. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are ?rst instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove some foreign bodies, but often removal by a specialist using suitable instrumentation and an operating microscope is required. In children, a general anaesthetic may be needed. ACUTE OTITIS EXTERNA may be a di?use in?ammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment should be local, using magnesium sulphate paste or glycerine and 10-per-cent ichthaminol. Topical antibiotic drops can be used and sometimes antibiotics by mouth are necessary, especially if infection is acute. Clotrimazole drops are a useful antifungal treatment. Analgesics and locally applied warmth should relieve the pain.

CHRONIC OTITIS EXTERNA producing pain and discharge, can be caused by eczema, seborrhoeic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, and the chronic disorder may be the result of swimming or use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments. TUMOURS of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, said to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to ?ll the ear canal, but may shrink considerably after treatment of the associated infection.

Diseases of the middle ear

OTITIS MEDIA or infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses. It may follow a cold, tonsillitis or sinusitis, and may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Primarily it is a disease of children, with as many as 1.5 million cases occurring in Britain every year. Pain may be intense and throbbing or sharp in character. The condition is accompanied by deafness, fever and often TINNITUS.

In infants, crying may be the only sign that something is wrong – though this is usually accompanied by some localising manifestation such as rubbing or pulling at the ear. Examination of the ear usually reveals redness, and sometimes bulging, of the ear drum. In the early stages there is no discharge, but in the later stages there may be a discharge from perforation of the ear drum as a result of the pressure created in the middle ear by the accumulated pus. This is usually accompanied by an immediate reduction in pain.

Treatment consists of the immediate administration of an antibiotic, usually one of the penicillins (e.g. amoxicillin). In the majority of cases no further treatment is required, but if this does not quickly bring relief then it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear. When otitis media is treated immediately with su?cient dosage of the appropriate antibiotic, the chances of any permanent damage to the ear or to hearing are reduced to a negligible degree, as is the risk of any complications such as mastoiditis (discussed later in this section). CHRONIC OTITIS MEDIA WITH EFFUSION or glue ear, is the most common in?ammatory condition of the middle ear in children, to the extent that one in four children in the UK entering school has had an episode of ‘glue ear’. It is characterised by a persistent sticky ?uid in the middle ear (hence the name); this causes a conductive-type deafness. It may be associated with enlarged adenoids (see NOSE, DISORDERS OF) which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the ?uid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of grommets (ventilation tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is less popular than it was a decade or so ago. MASTOIDITIS is a serious complication of in?ammation of the middle ear, the incidence of which has been dramatically reduced by the introduction of antibiotics. In?ammation in this cavity usually arises by direct spread of acute or chronic in?ammation from the middle ear. The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. The management of this condition in the ?rst instance is with antibiotics, usually given intravenously; however, if the condition fails to improve, surgical treatment is necessary. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.

Diseases of the inner ear

MENIÈRE’S DISEASE is a common idiopathic disorder of ENDOLYMPH control in the semicircular canals (see EAR), characterised by the triad of episodic VERTIGO with deafness and tinnitus. The cause is unknown and usually one ear only is affected at ?rst, but eventually the opposite ear is affected in approximately 50 per cent of cases. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures. OTOSCLEROSIS A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200; it customarily occurs early in adult life. An overgrowth of bone ?xes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.

Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)... ear, diseases of

Another name for the throat. The term throat is popularly applied to the region about the front of the neck generally, but in its strict sense it means the irregular cavity into which the nose and mouth open above, from which the larynx and gullet open below, and in which the channel for the air and that for the food cross one another. In its upper part, the EUSTACHIAN TUBES open one on either side, and between them on the back wall grows a mass of glandular tissue – adenoids (see NOSE, DISORDERS OF).... pharynx

Blockage of the nasal passage on 1 or both sides of the nose.

The most common cause of nasal obstruction is inflammation of the mucous membrane lining the passage (see nasal congestion).

Other causes include deviation of the nasal septum, nasal polyps, a haematoma (a collection of clotted blood) usually caused by injury, and, rarely, a cancerous tumour.

In children, enlargement of the adenoids is the most common cause of nasal obstruction.... nasal obstruction

One of a pair of oval tissue masses at the back of the throat on either side. The tonsils are made up of lymphoid tissue and form part of the lymphatic system. Along with the adenoids, at the base of the tongue, the tonsils protect against upper respiratory tract infections. The tonsils gradually enlarge

from birth until the age of 7, after which time they shrink substantially.

Tonsillitis is a common childhood infection.... tonsil

Certain skin diseases – particularly CHILBLAIN, ACNE, LUPUS and ERYSIPELAS – tend to affect the NOSE, and may be very annoying. Redness of the skin may be caused by poor circulation in cold weather.

Acute in?ammation is generally the result of a viral infection (see COLD, COMMON) affecting the mucous membrane and paranasal sinuses (see SINUSITIS); less commonly it results from the inhalation of irritant gases. Boils may develop just inside the entrance to the nose, causing pain; these are potentially troublesome as infection can spread to the sinuses. HAY FEVER is one distressing form of acute rhinitis.

Malformations are of various kinds. Racial and familial variations in the external nose occur and may be a reason for RHINOPLASTY. Di?erences in the size and shape of the nose occur, often forming the starting point for chronic in?ammation of the nose, perennial rhinitis (all the year round), hay fever, or ASTHMA. More commonly, obstruction results from nasal polyps or adenoids, leading to inhalation through the mouth. Adenoids are an overgrowth of glandular tissue at the back of the throat, into which the nose opens. Polyps are growths of soft jelly-like character: they arise from chronic in?ammation associated with allergic rhinitis, chronic sinusitis, asthma, and aspirin abuse. Large polyps can cause erosion of the nasal bones and should be surgically removed.

Bleeding (see HAEMORRHAGE).

Foreign bodies At ?rst these may not cause any symptoms, but in time they can cause obstruction of the affected nostril with a foul-smelling bloody discharge. The problem is common with small children who tend to push small objects into their noses. Foreign bodies require removal, sometimes in hospital. Anyone attempting to remove a foreign body should take care not to push it further into the nose.

Loss of sense of smell, or anosmia, may be temporary or permanent. Temporary anosmia is caused by conditions of the nose which are reversible, whereas permanent

anosmia is caused by conditions which destroy the OLFACTORY NERVES. Temporary conditions are those such as the common cold, or other in?ammatory conditions of the nasal mucosa or the presence of nasal polyps (see above). Permanent anosmia may follow in?uenzal NEURITIS or it may also follow injuries to the brain and fractures of the skull involving the olfactory nerves.

Injury to nose The commonest injury is a fracture of the nasal bones or displacement of the cartilage that forms the bridge of the nose. The nasal SEPTUM may also be displaced sideways by a lateral blow. Sporting activities, especially boxing and rugby football, are commonly a cause of nasal injury. If a fracture is suspected, or if there is substantial tissue swelling, an X-ray examination is necessary. Resetting a damaged bone should be done either immediately, before swelling makes surgery di?cult, or ten days or so later when the swelling has subsided. Results are usually good, ensuring a clear airway as well as a restored pro?le. It is not unusual for the cheek-bone to sustain a depressed fracture at the same time as the nose is broken. Careful assessment and prompt surgery are called for. (For more information on fractures, see under BONE, DISORDERS OF).

Rhinitis In?ammation of the MUCOUS MEMBRANE lining the nose. Symptoms include nasal discharge and obstruction, sneezing and sometimes pain in the sinuses. There are several types of rhinitis:

•Allergic – due to allergy to dust, pollen or other airborne particles. Also called hay fever, allergic rhinitis causes a runny nose, sneezing and local congestion. It affects up to 10 per cent of the population and is more common in people suffering from other allergic disorders such as asthma or eczema (see DERMATITIS). Skin tests help to identify the causative ALLERGEN which the sufferer can then try to avoid, although in the case of pollen this is di?cult. Decongestant drugs, ANTIHISTAMINE DRUGS, and CORTICOSTEROIDS may help, as can SODIUM CROMOGLYCATE inhaled regularly during the pollen season. A desensitisation course to a particular allergen sometimes provides long-term relief.

Atrophic rhinitis is caused by a deterioration in the nasal mucous membrane as a result of chronic bacterial infection, nasal surgery or AGEING. Symptoms include persistent nasal infection and discharge and loss of sense of smell. ANTIBIOTICS and, in some cases, OESTROGENS alleviate the symptoms.

Hypertrophic rhinitis results from repeated nasal infection, and is characterised by thickened nasal membranes and congestion of the nasal veins. Removal of thickened mucosa may help severe cases.

Vasomotor rhinitis occurs when the mucosa becomes oversensitive to stimuli such as pollutants, temperature changes or certain foods or medicines. It may occur as a result of emotional disturbances and is common in pregnancy.

Viral rhinitis occurs as a result of infection by the common cold virus; treatment is symptomatic. Sinusitis is sometimes a complication.... nose, disorders of

n. 1. facial expression, often a guide to a patient’s state of health as well as emotions. The typical facies seen in a patient with enlarged adenoids is a vacant look, with the mouth drooping open. A Hippocratic facies is the sallow face, sagging and with listless staring eyes, that indicates approaching death. 2. (in anatomy) a specified surface of a bone or other body part.... facies

pl. n. masses of *lymphoid tissue around the pharynx, usually referring to the palatine tonsils on either side of the *oropharynx. However, there is more tonsil tissue below the palatine tonsils, on the back of the tongue (the lingual tonsils), and small deposits around the openings of the *Eustachian tubes in the nasopharynx (the tubal tonsils). The tonsils are concerned with protection against infection. Together with the *adenoids, they form *Waldeyer’s ring.... tonsils

These may be of physical or psychological origin – or a combination of both. Di?culties may arise at various stages of development: due to problems during pregnancy; at birth; caused by childhood illnesses; or as a result of delayed development. Congenital defects such as CLEFT PALATE or lip may make speech unintelligible until major surgery is performed, thus discouraging talking and delaying development. Recurrent ear infections may make hearing dif?cult; the child’s experience of speech is thus limited, with similar results. Childhood DYSPHASIA occurs if the language-development area of the BRAIN develops abnormally; specialist education and SPEECH THERAPY may then be required.

Dumbness is the inability to pronounce the sounds that make up words. DEAFNESS is the most important cause, being due to a congenital brain defect, or acquired brain disease, such as tertiary SYPHILIS. When hearing is normal or only mildly impaired, dumbness may be due to a structural defect such as tongue-tie or enlarged tonsils and adenoids, or to ine?cient voice control, resulting in lisping or lalling. Increased tension is a common cause of STAMMERING; speech disorders may occasionally be of psychological origin.

Normal speech may be lost in adulthood as a result of a STROKE or head injury. Excessive use of the voice may be an occupational hazard; and throat cancer may require a LARYNGECTOMY, with subsequent help in communication. Severe psychiatric disturbance may be accompanied by impaired social and communication skills. (See also VOICE AND SPEECH.)

Treatment The underlying cause of the problem should be diagnosed as early as possible; psychological and other specialist investigations should be carried out as required, and any physical defect should be repaired. People who are deaf and unable to speak should start training in lip-reading as soon as possible, and special educational methods aimed at acquiring a modulated voice should similarly be started in early childhood – provided by the local authority, and continued as required. Various types of speech therapy or PSYCHOTHERAPY may be appropriate, alone or in conjunction with other treatments, and often the ?nal result may be highly satisfying, with a good command of language and speech being obtained.

Help and advice may be obtained from AFASIC (Unlocking Speech and Language).... speech disorders

Tonsillitis is the in?ammation of the TONSILS. The disorder may be the precurosor of a virus-induced infection of the upper respiratory tract such as the COMMON COLD, INFLUENZA or infectious MONONUCLEOSIS, in which case the in?ammation usually subsides as other symptoms develop. Such virus-induced tonsillitis does not respond to treatment with antibiotics. This section describes tonsillitis caused by bacterial infection.

Acute tonsillitis The infection is never entirely con?ned to the tonsils; there is always some involvement of the surrounding throat or pharynx. The converse is true that in many cases of ‘sore throat’, the tonsils are involved in the generalised in?ammation of the throat.

Causes Most commonly caused by the ?haemolytic STREPTOCOCCUS, its incidence is highest in the winter months. In the developing world it may be the presenting feature of DIPHTHERIA, a disease now virtually non-existant in the West since the introduction of IMMUNISATION.

Symptoms The onset is usually fairly sudden with pain on swallowing, fever and malaise. On examination, the tonsils are engorged and covered with a whitish discharge (PUS). This may occur at scattered areas over the tonsillar crypts (follicular tonsillitis), or it may be more extensive. The glands under the jaw are enlarged and tender, and there may be pain in the ear on the affected side: although usually referred pain, this may indicate spread of the infection up the Eustachian tube to the ear, particularly in children. Occasionally an ABSCESS, or quinsy, develops around the affected tonsil. Due to a collection of pus, it usually comes on four to ?ve days after the onset of the disease, and requires specialist surgical treatment.

Treatment Most cases need no treatment. Therefore, it is advisable to take a throat swab to assess the nature of any bacterial treatment before starting treatment. Penicillin or erythromycin are the drugs of choice where betahaemolytic streptococci are isolated, together with paracetamol or aspirin, and plenty of ?uids. Removal of tonsils is indicated: when the tonsils and adenoids are permanently so enlarged as to interfere with breathing (in such cases the adenoids are removed as well as the tonsils); when the individual is subject to recurrent attacks of acute tonsillitis which are causing signi?cant debility, absence from school or work on a regular basis (more than four times a year); when there is evidence of a tumour of the tonsil. Recurrent sore throat is not an indication for removing tonsils.... tonsillitis

(L.) Pers.

Synonym: T. hamiltonii Drumm.

Family: Papilionaceae; Fabaceae.

Habitat: All over India; also grown as green manure and as cover crop.

English: Purple Tephrosia, Wild Indigo.

Ayurvedic: Sharapunkhaa, Vishikha-punkhaa, Sarphokaa.

Unani: Sarponkhaa, Sarphukaa.

Siddha/Tamil: Kattu-kolingi, Kolingi, Paavali, Mollukkay, Kollukkayvelai.

Action: The drug is considered specific for the treatment of inflammation of spleen and liver (is known as Plihaa-shatru, Plihaari in Indian medicine).

Dried herb—diuretic, deobstruent, laxative. Given for the treatment of cough, bronchitis, bilious febrile attacks, insufficiency of the liver, jaundice (not effective in infantile cirrhosis), kidney disorders and for the treatment of bleeding piles, boils, pimples. Also used as a gargle. Root—decoction used in dyspepsia, diarrhoea, cough, bronchitis, adenoids, asthma and rheumatism. Juice is applied to skin eruptions. A liniment prepared from the root is employed in elephantiasis. Oil from seeds—specific against eruptions of the skin, eczema, scabies, leprosy. Seed extract—hypoglycaemic.

Powdered aerial parts prevented elevation of SGOP, SGPT and bilirubin levels.

Hepatoprotective effect of aerial parts was evaluated against (+)-galac- tosamine-induced and carbon tetra- chloride-induced hepatotoxicity in rats.

The leaves contain rutin and rote- noids (0.65-0.80% on dry basis). Rote- noid content is highest in the seed (1.60-1.80%).

The leaves also contain a triterpe- noid, lupeol, and beta-sitosterol.

Seeds contain a diketone-pongamol; a dimethylchromene flavanone iso- lonchocarpin; furanoflavones karan- jin and kanjone; a flavanone purpurin; and sitosterol. A flavonoid, lanceolarin B, is also present in seeds.

The plant extract led to marked lowering of blood glucose level in normal and alloxan-induced diabetic rabbits. In diabetic rabbits the extract exerted 60-70% hypoglycaemic effect as compared to tolbutamide.

Shveta Sharapunkhaa (stems: covered with white hair; flowers: pale pink or pale violet) is equated with T. villosa Pers.

The roots gave a prenylated fla- vanone 7-methylglabranin; pods contain rotenoids—villosin, villon, vil- losol, villosinol, villinol and villosone.

The fresh root is credited with hy- poglycaemic properties, but leaves did not show any such effect. The juice of the leaf is given in dropsy. Ayurve- dic classical texts describe it as a special drug for treating sterility in women.

Boiled leaves of T. uniflora subspecies petrosa (Kant-punkhaa) are used for the treatment of syphilis. The medicinal properties of the plant are more or less similar to those of T. purpurea, but to a milder degree.

T. spinosa Pers. (South India, ascending to 400 m in hills) is also known as Kant-punkhaa (Mulukolingi in Tamil Nadu).

The root is applied to inflammations and swellings of joints; a decoction is given in rheumatism.

Chalcones, spinochalones A and B and flemistrictin A have been isolated from the root. Spinochalone C and spinoflavonones A and B, and fulvin- ervin A have been isolated from the plant.

Dosage: Plant, root, seed—3-5 g powder. (CCRAS.)... tephrosia purpurea

Bed-wetting. Unconscious persistent discharge of urine in bed by children over three years. Possible hereditary tendency. Some cases psychological in origin: lack of security, marital disharmony, etc. Adenoids or worms sometimes responsible. Occurs mostly in boys where foreskin is too tight. Circumcism may be necessary. Parents should not scold but reserve extra affection and attention to patient.

Treatment. No drinks at night. Empty bladder at bedtime. Wake child 2 hours later to again empty bladder. During the day all caffeine drinks should be avoided: coffee, tea, Cola, etc.

Alternatives. Day-time drinks. Teas from any one:– American Cranesbill, Agrimony, Heartsease, Corn Silk, Liquorice root, Marshmallow root, Mullein, Raspberry leaves, Vervain, Shepherd’s Purse, Ladies Mantle, Uva Ursi. Formula. Bearberry 1; Cornsilk half; Skullcap 1. 1-2 teaspoons to each cup boiling water; infuse 15 minutes; half-1 cup hour before bedtime.

Tablets/capsules. Cranesbill (American). Passion flower. Valerian.

Formula. Equal parts: Ephedra, Valerian, Cranesbill (American). Dose. Powders quarter of a teaspoon. Liquid Extract 1 teaspoon. Tinctures 1-2 teaspoons. In water or honey, early evening and at bedtime. Eclectic School, America. (1) Horsetail 1; Cramp bark half. (2) Mullein 2; Cramp bark half. (3) Oil Thyme, 3 drops night and morning. (4) Oil Mullein (traditional, but still effective) 5 drops.

Thuja. “I have never failed to cure eneuresis in children and young people 3-15 years by giving 2-15 drops Liquid Extract Thuja in a tablespoon of water before each meal and at bedtime. (J.M. Stephenson MD)

Practitioner. Dec Jam Sarsae Co Conc BPC (1949), 1 fl oz. Liquid Extract Rhus Aromatica (Sweet Sumach) half a fluid ounce. Liquid Extract Passiflora 60 drops. Syrup Althaea 2 fl oz. Aqua to 8oz. Dose: 2 teaspoons in water thrice daily; last dose at bedtime. (Arthur Barker)

Tinctures. Formula. Equal parts: Agrimony, Corn Silk, Horsetail. Dose: 15-60 drops in water thrice daily.

Tincture Arnica: 1-2 drops in water at bedtime; not under 5 years.

Tincture Sweet Sumach. 10-15 drops in water thrice daily.

Diet: piece of cheese or peanut butter at bedtime helps level off the blood sugar level during sleep – important for normal brain function. Citrus fruits and chocolate aggravate. Cow’s milk suspect. ... enuresis

Secretory form. A common form of inflammation of the middle ear in children and which may be responsible for conduction deafness.

Causes: chronic catarrh with obstruction of the Eustachian tubes of dietetic origin. Starchy foods should be severely restricted. The ear is clogged with a sticky fluid usually caused by enlarged adenoids blocking the ventilation duct which connects the cavity with the back of the throat.

Conventional treatment consists of insertion of ‘grommets’ – tiny flanged plastic tubes about one millimetre long – which are inserted into the eardrum, thus ensuring a free flow of air into the cavity.

Fluid usually disappears and hearing returns to normal.

Tre atme nt. Underlying cause treated – adenoids, tonsils, etc. Sinus wash-out with Soapwort, Elderflowers, Mullein or Marshmallow tea. Internal treatment with anti-catarrhals to disperse. Alternatives:– German Chamomile tea. (Traditional German).

Teas. Boneset, Cayenne, Coltsfoot, Elderflowers, Eyebright, Hyssop, Marshmallow leaves, Mullein, Mint, Yarrow.

Powders. Combine: Echinacea 2; Goldenseal quarter; Myrrh quarter; Liquorice half. Dose: 500mg (two 00 capsules or one-third teaspoon), thrice daily.

Tinctures. Combine: Echinacea 2; Yarrow 1; Plantain 1. Drops: Tincture Capsicum. Dose: 1-2 teaspoons thrice daily.

Topical. Castor oil drops, with cotton wool ear plugs, Oils of Garlic or Mullein. If not available, use Almond oil. Hopi Indian Ear Candles for mild suction and to impart a perceptible pressure regulation of sinuses and aural fluids.

Diet. Gluten-free diet certain. No confectionery, chocolate, etc. Salt-free. Low-starch. Milk-free. Abundance of fruits and raw green salad materials. Supplements. Vitamins A, B-complex, C. E. ... otitis media – glue ear

The passage that runs from the middle ear into the back of the nose, just above the soft palate. The tube acts as a drainage channel from the middle ear and maintains hearing by opening periodically to regulate air pressure. The lower end of the tube opens during swallowing and yawning, allowing air to flow up to the middle ear, equalizing the air pressure on both sides of the eardrum.

When a viral infection such as a cold causes blockage of the eustachian tube, equalization cannot occur, resulting in severe pain and temporary impairment of hearing. A person with a blocked eustachian tube who is subjected to rapid pressure changes may suffer from barotrauma. Glue ear or chronic otitis media may occur if the tube is blocked, preventing adequate drainage from the middle ear. These conditions, which often result in partial hearing loss are more common in children. This is partly because their adenoids are larger and more likely to cause a blockage if they become infected and partly because children’s eustachhian tubes are shorter than those of adults.... eustachian tube

Accumulation of fluid in the cavity of the middle ear, causing impaired hearing. Persistent glue ear is most common in children. It is often accompanied by enlarged adenoids and frequently occurs with viral respiratory tract infections, such as the common cold. Usually both ears are affected. The lining of the middle ear becomes overactive, producing large amounts of sticky fluid, and the eustachian tube becomes blocked so that the fluid cannot drain away. The accumulated fluid interferes with the movement of the delicate bones of the middle ear.

Glue ear is sometimes first detected by hearing tests. Examination with an otoscope can confirm the diagnosis. In mild cases, the condition often clears up without specific treatment. If the condition persists, it may be necessary to insert grommets, which allow air into the middle ear and encourage fluid to drain.

Adenoidectomy may also be required.... glue ear

The passage connecting the nasal cavity behind the nose to the top of the throat behind the soft palate. The nasopharynx is part of the respiratory tract and forms the upper section of the pharynx. During swallowing, the nasopharynx is sealed off by the soft palate pressing against the back of the throat, preventing food from entering. It contains the lower openings of the eustachian tubes (passages connecting the back of the nose to the middle ear)and, in children, the adenoids, which can enlarge to block the nasopharynx, forcing the child to breathe through the mouth. nasopharynx, cancer of A cancerous tumour of the nasopharynx that usually spreads to the nasal cavity, nasal sinuses, base of the skull, and lymph nodes in the neck.

Cancer of the nasopharynx is rare in the West but common in the Far East. Most common at age 40–50, it affects twice as many men as women. One cause is believed to be the Epstein–Barr virus.

Common first signs are recurrent nosebleeds, a runny nose, and voice change. Loss of sense of smell, double vision, deafness, paralysis of one side of the face, and severe pain may develop.

Diagnosis is through a biopsy, MRI scans, and X-rays.

Treatment is usually with radiotherapy, but surgery may also be performed.

If treated early, the outlook can be good.... nasopharynx

A disorder in which there are episodes of temporary cessation of breathing (lasting 10 seconds or longer) during sleep.

People with sleep apnoea may not be aware of any problem during the night, but they may be sleepy during the day, with poor memory and concentration. Severe sleep apnoea is potentially serious and may lead to hypertension, heart failure, myocardial infarction, or stroke.

Obstructive sleep apnoea is the most common type and may affect anyone, but more often middle-aged men, especially those who are overweight. The most common cause is over-relaxation of the muscles of the soft palate in the pharynx, which obstructs the passage of air. Obstruction may also be caused by enlarged tonsils or adenoids. The obstruction causes snoring. If complete blockage occurs, breathing stops. This triggers the brain to restart breathing, and the person may gasp and wake briefly.

In central sleep apnoea, breathing stops because the chest and diaphragm muscles temporarily cease to work, probably due to a disturbance in the brain’s control of breathing. Causes include paralysis of the diaphragm and disorders of the brainstem. Snoring is not a main feature.People who are overweight may find losing weight helps.

Alcohol and sleeping drugs aggravate sleep apnoea.

In one treatment, air from a compressor is forced into the airway via a mask worn over the nose.

Night-time artificial ventilation may be needed.

Tonsillectomy, adenoidectomy, or surgery to shorten or stiffen the soft palate may be performed.... sleep apnoea

(OSA, obstructive sleep apnoea syndrome, OSAS) a serious condition in which airflow from the nose and mouth to the lungs is restricted during sleep, also called sleep apnoea syndrome (SAS). It is defined by the presence of more than five episodes of *apnoea per hour of sleep associated with significant daytime sleepiness. Snoring is a feature of the condition but it is not universal. There are significant medical complications of prolonged OSA, including heart failure and high blood pressure. Patients perform poorly on driving simulators, and driving licence authorities may impose limitations on possession of a driving licence. There are associated conditions in adults, the *hypopnoea syndrome and the upper airways resistance syndrome, with less apnoea but with daytime somnolence and prominent snoring. In children the cause is usually enlargement of the tonsils and adenoids and treatment is by removing these structures. In adults the tonsils may be implicated but there are often other abnormalities of the pharynx, and patients are often obese. Treatment may include weight reduction or nasal *continuous positive airways pressure (nCPAP) devices, *mandibular advancement splints, or noninvasive ventilation. Alternatively *tonsillectomy, *uvulopalatopharyngoplasty, *laser-assisted uvulopalatoplasty, or *tracheostomy may be required.... obstructive sleep apnoea