ENT clinics are particularly busy during the colder months. Snot, colds and viruses are a nuisance in winter. However, the medical speciality of ear, nose and throat medicine, or ENT for short, covers a much wider range of conditions, infections and disorders affecting the entire head and neck area. The field of ear, nose and throat medicine is fascinating simply because two sensory organs – the ears and the nose – fall within its scope of treatment. The editorial team at Leading Medicine Guide spoke to Prof. Dr. med. Dr. med. habil. Thomas P. U. Wustrow, a specialist in ear, nose and throat medicine at the ENT Center in Munich, to shed light on various aspects of this fascinating medical field. As it turned out, this holistically minded and extremely dedicated specialist is exactly the right person to talk to on this subject!
Is it a ‘common cold’ or actually the flu?
Viruses are annoying, persistent and, moreover, contagious. These include influenza, also known as ‘real’ flu or viral flu, which affects many people in Germany every year. In addition to a cough, a runny nose and hoarseness, symptoms include headaches and aching limbs, fatigue, bouts of fever, chills and, in some cases, nausea and diarrhea. Naturally, if a flu-like infection is suspected, it should be clarified whether it is the flu or perhaps ‘just’ a cold. “We are a flu center,” explains Prof. Wustrow with regard to the diagnosis, “and can determine within ten minutes, by means of a swab test, whether the patient is carrying the flu virus.” Such a clear diagnosis is important, because the flu is not a simple cold, but a serious illness that can drag on for weeks and confine the patient to bed.
In the first seven weeks of 2020 alone, the State Office for Health recorded 24,962 people with influenza in the state of Bavaria alone. That is approximately 50 per cent more than at the same time last year.
Flu vaccination – yes or no?
According to the Federal Center for Health Education, a flu jab is the most effective and cost-efficient measure to protect both yourself and those around you. At the same time, there are reports in the media of a creeping reluctance to get vaccinated. “There is a general ideological rejection of vaccination in Germany,” says Prof. Dr Wustrow, but explains: “In our practice, we are seeing an increase in the frequency of flu vaccinations. People have a justified fear of catching the flu. A flu vaccination is strongly recommended for older and frailer people.” Of course – one must bear in mind that in the winter of 2017/2018, around 25,000 people died from flu-like illnesses – and that was in Germany alone. “In addition to the at-risk group of older people and those with pre-existing conditions such as cancer, a flu vaccination is also a matter of responsibility for oneself and one’s fellow human beings among certain occupational groups. These include, for example, teachers or doctors – it applies to all professions that involve a lot of contact with people. Frequent flyers should also protect themselves!” recommends Prof. Dr Wustrow.
Persistent germs in the nose
If the flu is allowed to drag on, it can lead to life-threatening pneumonia. But even a “perfectly normal” cold can result in far-reaching complications. “If germs simply won’t go away and an illness has been poorly or inadequately treated and not fully recovered from, we speak of the illness dragging on, which can then become chronic,” warns Prof. Dr Wustrow.
The universally unpopular sinusitis, for example, is the result of persistent germs. “In the case of sinusitis, known as acute rhinosinusitis, an antibiotic can be taken to treat it if it is bacterial in origin and purulent. The inflammation in the sinuses disrupts ventilation, creating a perfect breeding ground for germs,” explains Prof. Dr Wustrow, adding: “For immediate additional relief, the sinuses can be suctioned using an endoscope.”
Of particular interest is the comment on the subject of “nasal rinses”. Here, Prof. Dr Wustrow says: “Nasal rinses, which are often promoted in television adverts, are not bad in themselves. But caution is advised if sinusitis is acute. Because then it’s all too easy for germs to be flushed deeper into the sinuses.” Germs can also become active again through incorrect nose-blowing or nose-picking. It is good if blowing your nose removes the secretions from the nose. But it is better to blow your nose gently than to blow it like an elephant trumpeting.
If conservative treatment does not help the patient, in cases of chronic inflammation, endoscopic surgery can be used to remove the diseased sinus mucosa and ensure proper ventilation. This involves removing blockages or obstructions such as nasal polyps. Prof. Dr Wustrow is additionally qualified in specialized head and neck surgery for such cases – as a patient, you should definitely bear this in mind!
And if the tonsils need to be removed …?
Let’s stay with the surgical aspect. Don’t you remember: in the past, when children suffered from frequent tonsillitis, it was very quickly recommended that they be removed. The prospect of plenty of ice cream made the idea of a hospital stay at least bearable. With the mouth wide open, the tonsils can be seen on the right and left of the throat – but that is about all most people know about them. And do we even need them, if they can be removed so quickly following a diagnosis? “The tonsils represent, among other things, the first line of defense after birth. All germs trigger the immune response in newborns. Tonsils are very important in this early stage of life; they are the first line of defense against germs attempting to enter the upper respiratory tract,” explains Prof. Wustrow, who also treats many children at the group practice in Munich.
Many children have enlarged tonsils. This can cause the airways to narrow, leading, for example, to a child snoring and experiencing breathing pauses during sleep. Persistent poor sleep, in turn, can lead to various problems and illnesses.
“Once children reach the age of six months or a year, the tonsils lose their function,” says Prof. Dr Wustrow. “The latest guidelines always recommend the administration of antibiotics as a first step in cases of frequent tonsillitis. Severe and persistent inflammation of the tonsils can eventually spread to the bloodstream and introduce toxins, raising concerns about secondary conditions. Tonsillectomies have also become less common, as this operation carries an increased risk of bleeding and requires a doctor to be present at all times to monitor the patient. Enlarged tonsils can be reduced in size without difficulty by means of a tonsillotomy. “There is no need to expect significant pain or heavy blood loss here, so this is one of the most common operations,” explains Prof. Wustrow, who always treats parents with great empathy and sensitivity when treating their child.
The fascination of the ear
There is a theory that the ear is the first fully functioning organ in humans. Babies can already hear while in the womb and clearly perceive sounds such as speech and music. A lack of responsiveness in a baby after birth may therefore well be linked to a hearing impairment or hearing loss. “I have to doubt whether the ear is the first fully developed organ; I tend to think it’s the heart. But nowadays, a newborn screening takes place within the first four days of life. This is carried out using clicking sounds and thus provides an objective measure of hearing,” explains Prof. Wustrow.
Around one to three in every thousand children in Germany are born with hearing impairments. These must be treated quickly, as they can severely impair the child’s development. During a newborn hearing screening, otoacoustic emissions are measured and the functionality of the inner ear and the outer hair cells is checked. The tests are completely painless and can be carried out easily while the baby is asleep.
“The first six weeks of life are crucial. Common causes of hearing loss in babies can include fluid build-up in the ear, enlarged adenoids, or actual congenital hearing loss. In such cases, brainstem audiometry is carried out, which measures the brain’s responses, similar to an EEG (electroencephalography). This allows us to examine the neural responses that occur when auditory stimuli are processed in the brain,” explains Prof. Dr Wustrow. Even if deafness is diagnosed, there is still a solution. Thanks to the surgical implantation of a so-called cochlear implant, a hearing aid for the deaf and those who have lost their hearing, hearing is made possible. The use of a cochlear implant is, of course, also possible in adults and is now even being used in people with severe hearing loss, i.e. patients with residual hearing.
It became clear during the conversation with Professor Dr Wustrow that he is a truly passionate doctor. Prof. Dr Wustrow has enjoyed the excellent collaboration with his three colleagues at the ENT group practice in Munich, which has been in existence since 1959, since 1996, and he contributes his expertise there with great dedication. Thank you very much for the fascinating insight into the world of ear, nose and throat medicine! You can find much more information about the ENT Center in Munich and Prof. Dr Wustrow here!
