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Monday, 30 November -0001

YOUR HEALTH Dr James Le Fanu: 21 September

Curing chronic sinusitis, treating troublesome tonsils and the unexpected benefits of toothpaste for mouth-ulcer sufferers

Written by Dr James Le Fanu
The human body is a masterpiece of elegant design where even its seemingly most insignificant features prove to be indispensable: the complex visual system would be useless without those lubricating tears to keep the cornea moist, without earwax we would be prone to recurrent ear infections, and so on.

Indeed, it is difficult to see how the body could be improved on, although obstetrician James Drife has suggested the human race would be better off were women to ovulate just once a year. 'An annual mating season would release humans from their morbid yearround obsession with sex,' he notes.

Beyond that, it would certainly be useful if the nerves and muscles could regenerate themselves, as they do in flat worms, and if we had more than just two sets of teeth to see ourselves through life. The general impression however, would seem to be, as the late biologist Stephen Jay Gould remarked, 'There is nothing to fix so we should leave well alone.'

And when some part or other does malfunction, an appreciation of this elegance of design is also helpful when seeking to put things right – as well illustrated by recent developments in the treatment of sinusitis. The purpose of the sinuses is to humidify the inspired air on its way down to the lungs while filtering out bacteria, viruses and other potentially noxious substances. They are, as a result, vulnerable to infection, which can lead to chronic sinusitis where they become filled with a sort of infected glue, while the head feels heavy and bunged up. At one time, surgeons sought to improve matters by making a hole at the base of the sinuses so they could drain by gravity, while periodically washing them out to get rid of the accumulated gunge – but the results were never very satisfactory.

Then, around 10 years ago, a pioneering group came up with a much simpler procedure known as functional endoscopic sinus surgery. This involves introducing a thin tube into the nose and opening the passageways into the sinuses, thus ensuring a better flow of air through them. This facilitates the elimination of noxious substances while permitting the damaged membranes to recover – and has indeed proved to be much more effective.

This week's medical problem comes courtesy of a lady from Kent writing on behalf of her son who is troubled with small (and rather offensive) 'stones' in his tonsils at the back of the throat. He wonders whether there might be some relatively straightforward way of getting rid of them.

These 'stones' are caused by food particles that get lodged in the crevices of the tonsils and then interact with local bacteria to form hard white particles on the surface. A rigorous regime of oral hygiene should prevent their formation – including rinsing the mouth with salted water several times a day and drinking plenty of water to keep the mouth well hydrated. There is also a Waterpik device, which generates a thin stream of water under pressure, which can be used to painlessly dislodge the 'stones' when they occur.

Down in the mouth

There are several possible treatments for recurrent mouth ulcers, but a lady from Chorley recounts her fortuitous discovery of the little-known preventive effects of toothpaste: 'I had a whim to try a bicarbonate of soda toothpaste and was pleased to note that after a couple of months my mouth became ulcerfree.' She wrote to the manufacturer saying it was a pity that it did not advertise this to help more sufferers. The response? It would cost too much to prove this benefit clinically.

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