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| Sunday, 27 March 2005 |
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Features |  |
| News Business Features Editorial
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What we should know about : The wet ear by Dr. W. Ratnayake, Consultant ENT Surgeon A wet ear is often worrying and embarrassing to the person who is experiencing it or to the parents if it is in a child. Normal wetness
Sometimes wetness can be a normal phenomenon like wax, which is produced in the ear canal by a special type of wax-forming glands. This wax is often moist, slightly brownish in colour or less commonly whitish. Soft wax is usually seen at the opening of the ear canal especially at the time of waking up. This should not cause alarm to anybody as it is normal. Sometimes wetness of ear may be associated with irritation which makes the patient scratch the ear. Itching of the ear is most often seen in skin problems of the ear canal like eczema, psoriasis and dandruff of the ear canal. Itching is also seen in allergic disorders like catarrh (allergic rhinitis) which in addition causes irritation of throat, eyes and nose. Sometimes ear scratching can be a habit or a symptom of stress. Caution Ear scratching can cause injuries to the skin of ear canal and worst of all, to the ear drum, which can lead to a permanent hole in the ear drum. This habit can also lead to infections of the ear. A wet ear can be due to infections involving the external ear or middle ear and these conditions are very common. An infection of the external ear (otitis externia) is either due to bacteria or fungus. Bacterial otitis externa is a very painful condition. Often this pain doesn't get adequately controlled with simple pain killers like Asprin and Paracetamol. The ear is very tender to touch, and this patient even resists touching of the ear by the others.
However an external ear infection due to fungus is usually not painful, but very itchy, made more uncomfortable by a blocked feeling. If one attempts to clean the ear one would notice blackish material in a white background giving the impression of 'wet newspaper'. How does one get otitis externa? It is often self made. Traumatic attempts at ear cleaning, installation of oils, and overuse of antibiotic ear drops are common causes. Overuse of antibiotic drops can cause allergic reactions, as well as fungal infections. Water getting into the ear during swimming, and also polluted water getting into the ear can result in otitis externa. Chlorinated water can cause a reaction in the skin of the ear canal and eventually lead to an infection. An ear discharge can arise from the middle ear commonly due to an infection (otitis media). Otitis media is divided into two broad groups, the 'safe' type and the 'unsafe' type. Fortunately, the 'safe' type is more common. Often this presents with a profuse mucus like discharge especially noticed in children. Such a discharge is embarrassing to the patient. Pain is rare, usually seen only during the initial days of the first acute attack. Later, the disease recurs often following colds and sore throats. The Eustachian tube that runs from the back of the nose to the middle ear provides a good path for the infection to speed to the middle ear. Recurrent infections lead to a permanent hole in the ear drum. Such a person should avoid water getting into the ear by wearing ear plugs during baths, and also avoid swimming and diving. The 'smelly' ear The 'unsafe' type of middle ear infection can cause dangerous complications. The discharge is scanty and sometimes swells. A 'smelly' discharge is thus a bad sign. It can lead to infection of the skull bone behind the ear (Mastoiditis), infection of the covering of the brain (Meningitis), collection of pus inside the brain (abscess) damage to the nerve, supplying the muscles of the face, causing paralysis of the face. Sometimes, these complications can lead to patient's death. Curable However, the picture is not all that grim. All the above diseases are curable, either by drugs or by surgery, what is important is an early visit to the doctor when the ear is abnormally wet. Then treatment can be started before complications arise. The relationship between mind and body by Dr. Danister L. Perera One part of Ayurveda deals only with maintaining the health and staying away from diseases. The word health here does not mean physical health but also spiritual and mental health. Many of us may not have any physical problem but still may not be feeling happy or comfortable. Problems like depression, anxiety, nervousness, insomnia originate mainly due to sick minds and souls. Unfortunately in the modern world most of our actions and activities which we perform to become happy and peaceful, are related to the physical body and materialism only. We never or rarely pay any attention to the other half, which is equally important the minds and the souls. Ayurveda sees a strong connection between the mind and the body, a huge amount of information is available regarding this relationship. To many of us, these words might sound outdated or of no use in modern society. But they are responsible for a half of our health. Our actions, foods and life styles, which we are following to get happiness and peace, may not be healthy to our mind and soul. That is why in spite of following the best health rules and taking all precautions, we are not happy and peaceful. Most of the time we feel anxious, depressed and insecure. Why then are we following them? This is because no one has ever taught us about the other half of our life. We normally do something, whatever it may be, to get enjoyment, happiness and peace. And we put in our best efforts and resources to achieve this. But we are not able to achieve it even after our best endeavour. This indicates that there is something wrong in our approach or something is missing somewhere. That is our mind and soul. We simply can't ignore an important topic, related to our health. The mind and the soul require equal attention, as does our body. All through our life we are making all possible efforts to make our body happy and comfortable. Our habits or emotions like anger, greed, passion, attachment, jealousy, not caring for other creatures, not speaking truth, creating problems for others, not respecting elders, narrow mindedness and being selfish, are unhealthy for us. We may not realize this but they are the cause, for most of our mental problems. Ayurveda is the perfect answer to this question. It helps us in understanding each individual at a very subtle personal level and giving a detailed description about diet, daily routine, life-style, actions and activities to be followed. It teaches how to live in society and in the universe without disturbing the natural balance. Various technologies in the modern medical science a hundred years ago might be having different versions today. While some of them are very effective in relieving ailments and some of them have failed in curing human discomforts. It is explicitly proved that most of natural therapies are successfully capable of healing without side-effects or complications. We should use modern science and technology to research ancient traditional systems and if they are good, then use them to help the suffering people. Since the aim of any medical system is to give relief to the patient, there is no harm in combining the best from different systems and complimenting each other for the service of humanity. Tests you should undergo during pregnancy With Dr. Hemantha Dodampahala, Consultant Gynaecologist and Obstetrician Pregnancy is the time for you to take extra care of yourself and maintain good health. In the coming weeks you will have to undergo various tests including blood tests and ultra sound scans to check whether you are 'free' of any illness. It is mainly for the benefit of your unborn baby. The tests are necessary even if you did not have any health problem earlier, as there may be a 'hidden risk'. Maintaining the haemoglobin level is important throughout the pregnancy. Low haemoglobin level may lead to various problems in your day-to-day activities and it will badly affect your baby's health. So, the haemoglobin test is a priority. Checking the haemoglobin levels to determine the quality of blood in your body is also important. Then there is the blood sugar status. If you suffer from diabetes it should be controlled before you think of becoming pregnant. Blood sugar test should be done preferably after meals. Urine tests are also important during pregnancy. Generally urine tests are done to check whether you are passing proteins or whether you have urine infections. These tests are also necessary to know the urine sugar status. The results of the urine test will be helpful in more specific tests like sugar levels in the blood and kidney test. If the mother has diabetes a series of tests for sugar will be done through the days, because it needs 24-hour control. If the mother had diabetes previously and the sugar levels are normal now, she will have to undergo tolerance test. If needed the doctor will prescribe some advanced tests. The Venereal Disease Research Laboratory Test (VDRL) is another important check-up to be done during pregnancy. This is to detect syphilis and if the VDRL test is positive you will be subjected to some other tests as this test alone will not give a clear picture about the problem. However, these tests are performed during the first three to four months of pregnancy. If the tests show any abnormality, you have to start on appropriate treatment. If the haemoglobin level is low you need to be given iron. From all the tests the Ultra Sound Scan is the most important as it shows the actual position of your baby. Most of the State hospitals and private health institutions have Ultra Sound Scan facilities but the request has to come from your obstetrician. Knowing your blood group is also important during pregnancy as it will ensure the availability of the required blood in emergency situations. Mercury in your mouth by Dr. G.D. Anna Kumaraswamy Today, use of metal devices in dentistry is widespread. In early days silver and gold were the chosen metals for dental fillings, because of their biocompatibility. Conventional Silver Amalgam consisted of an alloy of 70% Silver the rest Copper and Tin. However this composition of amalgam posed limitations on the usage as far as the achieved strength of the fillings, its condensability and adaptation. Thus arose the advent of High Copper - low Silver Amalgams without the High Resistant Gamma Phase, known as Non-Gamma 2 Silver Amalgams composed of an alloy of 46-48% Silver, 23-24% Copper and the rest Tin. the increased copper and tin portions created a good flux when mixed with Mercury thus presenting good physical properties, such as high lustre, excellent biocompatibility and very high corrosion resistance. New regulations in certain European countries however now restrict the use of Silver Amalgam due to the possible dangers of Mercury poisoning. Notwithstanding, Silver Amalgam still remains the dentist's best choice for economically restoring damaged teeth in the posterior region. It must be noted that the use of industrial and laboratory grades of Mercury, instead of the British Pharmacopoeia grade causes Amalgam fillings to corrode within the cavity and is attributed to the corrosive nature Mercury itself. On account of the high price of BP grade Mercury, a lot of Mercury used here by dental surgeons knowingly or unknowingly is the industrial or laboratory grades. Furthermore, screws posts, crowns, pins etc used by dentists are also made of ordinary quality stainless steels, which tend to tarnish and corrode. Similarly with advances made in dentistry the correction of teeth technically termed as Orthodontic Treatment has gained popularity especially with young females and several dental practitioners who are not qualified "Orthodontists" openly carry out this financially lucrative practice. The use of metal devices here is extensive and it is therefore extremely important to use good stainless steel of biocompatible non-corrosive quality i.e. Medical quality steel, more importantly because these metal devices remain in the patients' mouth for periods extending from 6 to 24 months. Titanium is therefore the metal of preference for orthodontic devices and implants. Titanium offers very high biocompatibility and comfort to the patient by its extremely low weight. Nevertheless, the cost of devices made from titanium is comparatively higher to Medical Grade Stainless Steel. As a result of the possible danger of metal poisoning caused by use of low quality Stainless Steel for production of metal devices used in medicine, it is very important that practitioners and patients ensure that the source of such metal devices are reliable before they are applied especially in the oral cavity. Non-medical grade stainless steel devices are observed to tarnish and get coated with green fungus within a short period of placement, thereby reducing oral hygiene on one hand and more importantly a potential source for metal poisoning. Guidelines on management of lipid disorders - Sri Lanka Medical Association (SLMA) With the increase in life expectancy and decline of infectious diseases, the incidence and prevalence of non-communicable diseases have increased. Coronary heart disease (CHD) has been the number one killer from 1995 to 2000. CHD is mainly due to atherosclerosis, which is a condition characterized by deposition of fat inside the arteries causing narrowing and obstruction to blood flow. Moreover, the importance of coronary heart disease and the other complications of advanced atherosclerosis (example, strokes, peripheral arterial disease) are likely to increase rather than decrease in the years ahead both in terms of their impact on health and their economic burden.) In view of this, control of risk factors for atherosclerosis has become an urgent health need. The major risk factors for atherosclerosis fall in to two categories; Modifiable risk factors: elevated lipids, high blood pressure, diabetes, smoking, obesity, physical inactivity. Non-modifiable risk factors: age, male sex and family history of premature CHD. The Sri Lanka Medical Association (SLMA) realizing the significance and the magnitude of this problem has embarked on a programme that would develop guidelines for the doctors on the management of risk factors. Management of diabetes mellitus and hypertension has already been dealt with in the national guidelines developed and published by the Sri Lanka Medical Association. The new publication, 'Guidelines on Management of Lipid Disorders in Sri Lanka' deals with lipid management in the context of coronary heart disease prevention. In this guideline, the aim of the SLMA is to focus on the lipid management of those who have developed symptoms of coronary heart disease or other major atherosclerotic disease, and those who are at high risk of developing such diseases in the future. They are 1. Patients with established coronary heart disease or other atherosclerotic disease. 2. Individuals who are at high risk of developing coronary heart disease or other atherosclerotic disease, because of a combination of risk factors including smoking, raised blood pressure, lipids (raised total cholesterol and low density lipoprotein (LDL) cholesterol, low high density lipoprotein (HDL) cholesterol and raised triglycerides) raised blood glucose, family history of a premature coronary disease or who have severe hypercholesterolaemia or other forms of dyslipidaemia, hypertension or diabetes. 3. Close relatives of patients with early onset of coronary heart disease or other atherosclerotic disease, and of healthy individuals at particularly high risk. - Dr.Bandula Wijesiriwardena and Dr. J. Indrakumar
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The discharge from the ear in this condition is scanty, pain being the
most prominent presenting feature. 
