Ear, Nose and Throat Troubles

A large number of complications can occur in a poorly controlled, long standing condition of diabetes.

 

Most of these are of vascular nature, like coronary artery disease causing heart attack or cerebrovascular disease, causing a stroke. Additionally, a person with diabetes is prone to various infections. In ENT diseases, increased infections are the most frequent problem. An uncontrolled diabetic is prone to infections because his defense mechanisms are not geared towards the same level of efficiency as a person without diabetes.

 

ENT INFECTIONS

The most common infections, in general, are what we call the Upper Respiratory Infections. These are infections of the throat, sinuses and bronchi, which are usually viral, but rarely bacterial as well. These infections tend to be recurrent in a diabetic and also require longer time for the patient to recover. These infections are characterised by a running nose or sore throat and fever followed by a cough, which may last from a few days to a few weeks. Although in viral infections, antibiotics are not indicated, this viral infection may also be accompanied by a super added bacterial infection. Thus necessitating a brief antibiotic therapy for 5–7 days is required.

Ear infections, mainly what we call ‘middle ear infections’ are also more frequent in people with diabetes. These occur when a throat or sinus infection spreads into the middle ear through a tube, called eustachian tube. These infections cause severe ear pain and fever, especially in children and if not treated promptly, result in a perforated ear drum. This can be followed by a chronic discharging ear, especially with inadequate treatment.

 

MALIGNANT OTITIS EXTERNA

There are two very severe infections occurring specifically in a diabetic person. Both of these are fortunately very rare, but once acquired can be quite disabling and life threatening. One of these involves the external ear (what you routinely recognise as ear). With a trivial injury or even without a recognisable injury, the ear gets acutely inflamed with very high fever. This is medically termed malignant otitis externa, malignant because it is so rapidly progressing. It is a bacterial infection, which calls for the use of potent antibiotics. It also spreads like fire and hence is difficult to treat.

 

MUCORMYCOSIS

Another typical infection, which is serious, affects sinuses. It is caused by a fungus and is called mucormycosis. Fever is not a prominent feature of this infection. It usually starts in the nasal sinuses, where it affects the nasal cartilage. Gradually, the cartilage turns dark and is destroyed, at time causing holes in the cartilages. It also spreads to the palatal area, where it can deform the bone and create holes. This infection is diagnosed by a quick biopsy of the nasal cartilage. Once confirmed, an antifungal antibiotic is given for 2–4 weeks. Patient may need surgery to remove the dead bone and cartilage and eradicate the infection, if not fully controlled by the antibiotic. After the infection is cured, some reconstructive surgery may be required to restore the bones and cartilages.

 

SPECIFIC ENT PROBLEMS THAT ARISE DUE TO DIABETES MOUTH

Damage to the gums, erosion or caries of the teeth, delayed healing of gum after tooth extraction, damage to the teeth at the base caused by increased acidity of saliva, aching teeth, spongy bleeding gums, staining of teeth by deposition of lime salts.

TONGUE: Aphthous stomatitis or recurrent canker sores, thrush (fungal infection with white areas), large red tongue sometimes covered with a black fur along the centre, redness of the lining of the mouth, which looks glazed and feels dry.

BREATH: Sweet sickly odour of the breath due to presence of acetones.

TASTE: Patients may complain of a sweet taste in the mouth.

THROAT: Persistently dry throat, with secretions being thick and the throat looking red and shiny. This associated with repeated boils on the body, cramps in the legs, mental hebetude (slowness or dullness), and lassitude (state of physical or mental weariness and lack of energy), are almost always diagnostic of diabetes.

CHEST: Tuberculosis of the lungs.

EARS: Loss of hearing, called sensorineural hearing loss can occur.

NOSE: Dryness of the mucous membrane and loss of smell, sometimes totally, if the nerves carrying smell are damaged by diabetes.

 

TREATMENT FOR DIABETES

• People with type 1 diabetes cannot make insulin because the beta cells in their pancreas are damaged or destroyed. Therefore, these people will need insulin injections to allow their body to process glucose and avoid complications from hyperglycaemia.

• People with type 2 diabetes do not respond well or are resistant to insulin. They may need insulin shots to help them better process sugar and to prevent long-term complications from this disease. Persons with type 2 diabetes may first be treated with oral medications, along with diet and exercise. Since type 2 diabetes is a progressive condition, the longer someone has it, the more likely they will require insulin to maintain blood sugar levels.

• Lifestyle changes such as being physically active and losing excess weight, are the best ways to reverse metabolic syndrome, improve the body’s response to insulin, and reduce risk for type 2 diabetes and CVD.

 

DIET

  1. Meals should consist of more proteins, and calories should be obtained from fresh fruit and vegetables
  2. Oil in food should be severely restricted.
  3. Diabetics must eat small meals every two hours rather than large meals
  4. All foods can be eaten unless there is a problem of high triglycerides and cholesterol in which case diet has to be accordingly adjusted.
  5. Patients with type 2 diabetes generally are put on a 1,500 to 1,800 calorie diet per day to promote weight loss and then the maintenance of ideal body weight. However, this may vary depending on the person's age, sex, activity level, current weight, and body style. Additional calories may be added or subtracted by a dietician.
  6. Nicotine and caffeine are known to raise blood sugar levels and keep them high. Therefore, they need to be avoided or limited.
  7. Drinking plenty of fluids to keep blood sugars diluted is a good option. Replace fluid in the body lost by dehydration, where high blood sugars dry out the body cells and fluid is lost by frequent urination.
  8. Alcohol lowers blood sugar contrary to common belief. Diabetics on medications must never consume alcohol on an empty stomach.
  9. Increasing green leafy salad snacks and the use of whole Indian spices like black pepper, cardamom, cinnamon and tulsi (basil) in cooking keep blood sugars low. Vinegar also helps lower down blood sugar levels.

 

 

By Dr. Hemraj Chandalia & Dr. Dillon D’Souza

Easy reading is damn hard writing.