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Environmental ear, nose and throat problems in children
International Journal of Pediatric Otorhinolaryngology 49 Suppl. 1 (1999) S253 – S255 www.elsevier.com/locate/ijporl
Environmental ear, nose and throat problems in children R. Fior, IFOS Standing Committee for Pediatric ORL Via Belpoggio 2, 34123 Trieste, Italy
Keywords: Environment; Epidemiology; Public health
We are all well aware of the potential damage to health and general welfare posed by the increasing deterioration of the air resource and we also know that changes in the environment — whenever they have been too rapid — have led to the disappearance or reduction to insignificance of species and even dominant orders of plants and animals for lack of adaptative responses. The human race is certainly better able to resist such negative influences and to develop means of forestalling such cataclysmic consequences; on the other hand, the increasing numbers of the world’s population which still exists on the same air resources has led to changes in the atmosphere which are too rapid and too large to allow for an adaptive adjustment which would normally need many generations. The first ‘massive pollutant’ has been coal as a source of energy, with its sulphurous smoke. The first complaint (by the nobility) is recorded in the British Kingdom during the reign of Edward I (1272–1307). In the present century, a high price had to be paid to ‘clean’ the atmosphere of cities like London and many other urbanized areas around the world. A marked improvement was obtained until another fossil source of energy, petroleum, became available and was used not only for industry and heating but for transportation and numerous other purposes. Petrol acts not
only by itself in its various forms, but further, in combination with solar light, humidity and temperature, it may form new intermediate and terminal compounds which are potentially dangerous for health. Thus, just to give an example, to prevent the formation of toxic ozone, we must control the production of hydrocarbon vapours and nitrous oxides, which are not harmful by themselves. Thus, we have passed from an era dominated by a single global pollutant, coal, to an epoch where we and our children inhale daily a combination of hydrocarbons caused by heating, manufacturing and transportation, to name but the most common. These substances, however, are only those that are present globally in large quantities, but we know many more pollutants—i.e. substances which, being present in sufficient concentration, are known to produce measurable effects on man or other animals, vegetation or material. Electromagnetic radiations have been recently indicated as another source of invisible and not easily measurable pollution. Finally (for the time being), nuclear contamination from experiments with atomic devices, unfortunately resumed a few weeks ago, will presumably stay with the human race for at least five centuries. Nowadays, the air we breathe is an aerosol, including particles of carbon, metal, tar, resin,
0165-5876/99/$ - see front matter © 1999 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 5 8 7 6 ( 9 9 ) 0 0 1 7 1 - 8
S254
R. Fior / Int. J. Pediatr. Otorhinolaryngol. 49 (1999) S253 – S255
pollen, fungi, bacteria, oxides, nitrates, sulphates, chlorides, fluorides and silicates — a list obviously incomplete. These are classified as primary emissions, coming directly from identifiable sources, but we know that in the air pollutants may interact among themselves or react with the atmosphere, sometimes with the help of light. The indoor air pollutant which is more likely to harm children is tobacco smoke. Again, for this pollutant, an English king, James I (1566 – 1625), expressed his opinion when he defined smoking as ‘‘a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lung and in the black stinking fume thereof nearest resembling the horrible stygian smoke’’. Today we know that this so common pollutant also contains another powerful irritant, formaldeyde. A recent study in Canada has shown that children whose mothers (or, worse, fathers too) smoke more than ten cigarettes a day have a double incidence of otitis, regardless of all other socio-economic or cultural factors. Children are more vulnerable to pollution in the air as they have more need for oxygen, a fact which leads to more rapid breathing and inhalation through narrower air passages of higher levels of pollutants per kilogram of body weight. Being unaware of these risks, they do not protect themselves and spend more time than adults in vigorous outdoor activities. Finally, until a certain age, they live in an anthropospheric level where car fumes have the highest concentration. Organs more directly affected are the nose and the larynx. The nose tries to prevent the passage of noxious substances in the lower airways and to reinsert them in the expired air, a cycle which, however, cannot be completed, leading to accumulation in the mucosa and to local irritation, inflammation and eventually infection. Part of these chemicals are also absorbed through the mucosa, and mechanisms of oxidation, reduction, conjugation and degradation intervene to eliminate them from the organism, sometimes resulting in an even more negative situation. Also the immune system is affected, leading to allergy. Consequently, the
essential filtering function of the nose becomes less and less efficient and pollutants eventually reach more easily the larynx and the lower airways where the same toxic effects are produced. Even the ear may become affected when the mucosa of the tuba is altered and ventilation of the middle ear becomes impaired. Children are innnocent victims of pollution, and studies in Australia, New Zealand, Switzerland and Wales indicate that there is a higher prevalence of allergy, asthma and wheezing in children now than there was 15–25 years ago. As you can understand, the problem is complex and far from being solved: field investigations all over the world, experimental research, clinical, laboratory and functional studies are needed not only to know more but furthermore to provide evidence to health authorities on the growing danger of poisoning our atmosphere and to force them to take measures for prevention. Six years ago, representatives of 172 nations, including 108 heads of state, met in Rio de Janeiro to discuss and tackle the problem of pollution: grand-sounding statements of principle and noble declarations were followed by the presentation of plans of action and the signing of agreements: a better world beckoned. Five years on, when the second world summit, called Rio Plus Five, met in summer 1997 in New York, those present could only register the failure of most of these goals. In fact, industrial countries had to admit that all the Rio targets had been missed. To name but a few: whereas Rio had set a target of returning carbon dioxide emissions to 1990 levels, today’s levels are steadily increasing, not only in developed countries, but China’s emissions will very likely exceed those of the USA by 2005; safe drinking water is not accessible to 20% of the world’s population; and in the Amazon alone an area more than twice the surface of Belgium has been deforested. Dirty industries have not been stopped or controlled and car fume levels are continuously increasing. Not only has little been done to improve our global situation of pollution and practically nothing to fight poverty (the world’s poorest 20% enjoy—a tragic irony—only 1.1% of global income
R. Fior / Int. J. Pediatr. Otorhinolaryngol. 49 (1999) S253 – S255
as compared to 2.3% in 1960), but fossil fuel and transport multinational industries have been working to challenge the scientific evidence for climate change and have influenced the Kyoto
.
S255
conference of last December. Industrialized countries, in an unholy alliance with poor countries rich in natural resources, are set at minimizing these vital issues.
Environmental ear, nose and throat problems in children R. Fior, IFOS Standing Committee for Pediatric ORL Via Belpoggio 2, 34123 Trieste, Italy
Keywords: Environment; Epidemiology; Public health
We are all well aware of the potential damage to health and general welfare posed by the increasing deterioration of the air resource and we also know that changes in the environment — whenever they have been too rapid — have led to the disappearance or reduction to insignificance of species and even dominant orders of plants and animals for lack of adaptative responses. The human race is certainly better able to resist such negative influences and to develop means of forestalling such cataclysmic consequences; on the other hand, the increasing numbers of the world’s population which still exists on the same air resources has led to changes in the atmosphere which are too rapid and too large to allow for an adaptive adjustment which would normally need many generations. The first ‘massive pollutant’ has been coal as a source of energy, with its sulphurous smoke. The first complaint (by the nobility) is recorded in the British Kingdom during the reign of Edward I (1272–1307). In the present century, a high price had to be paid to ‘clean’ the atmosphere of cities like London and many other urbanized areas around the world. A marked improvement was obtained until another fossil source of energy, petroleum, became available and was used not only for industry and heating but for transportation and numerous other purposes. Petrol acts not
only by itself in its various forms, but further, in combination with solar light, humidity and temperature, it may form new intermediate and terminal compounds which are potentially dangerous for health. Thus, just to give an example, to prevent the formation of toxic ozone, we must control the production of hydrocarbon vapours and nitrous oxides, which are not harmful by themselves. Thus, we have passed from an era dominated by a single global pollutant, coal, to an epoch where we and our children inhale daily a combination of hydrocarbons caused by heating, manufacturing and transportation, to name but the most common. These substances, however, are only those that are present globally in large quantities, but we know many more pollutants—i.e. substances which, being present in sufficient concentration, are known to produce measurable effects on man or other animals, vegetation or material. Electromagnetic radiations have been recently indicated as another source of invisible and not easily measurable pollution. Finally (for the time being), nuclear contamination from experiments with atomic devices, unfortunately resumed a few weeks ago, will presumably stay with the human race for at least five centuries. Nowadays, the air we breathe is an aerosol, including particles of carbon, metal, tar, resin,
0165-5876/99/$ - see front matter © 1999 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 5 8 7 6 ( 9 9 ) 0 0 1 7 1 - 8
S254
R. Fior / Int. J. Pediatr. Otorhinolaryngol. 49 (1999) S253 – S255
pollen, fungi, bacteria, oxides, nitrates, sulphates, chlorides, fluorides and silicates — a list obviously incomplete. These are classified as primary emissions, coming directly from identifiable sources, but we know that in the air pollutants may interact among themselves or react with the atmosphere, sometimes with the help of light. The indoor air pollutant which is more likely to harm children is tobacco smoke. Again, for this pollutant, an English king, James I (1566 – 1625), expressed his opinion when he defined smoking as ‘‘a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lung and in the black stinking fume thereof nearest resembling the horrible stygian smoke’’. Today we know that this so common pollutant also contains another powerful irritant, formaldeyde. A recent study in Canada has shown that children whose mothers (or, worse, fathers too) smoke more than ten cigarettes a day have a double incidence of otitis, regardless of all other socio-economic or cultural factors. Children are more vulnerable to pollution in the air as they have more need for oxygen, a fact which leads to more rapid breathing and inhalation through narrower air passages of higher levels of pollutants per kilogram of body weight. Being unaware of these risks, they do not protect themselves and spend more time than adults in vigorous outdoor activities. Finally, until a certain age, they live in an anthropospheric level where car fumes have the highest concentration. Organs more directly affected are the nose and the larynx. The nose tries to prevent the passage of noxious substances in the lower airways and to reinsert them in the expired air, a cycle which, however, cannot be completed, leading to accumulation in the mucosa and to local irritation, inflammation and eventually infection. Part of these chemicals are also absorbed through the mucosa, and mechanisms of oxidation, reduction, conjugation and degradation intervene to eliminate them from the organism, sometimes resulting in an even more negative situation. Also the immune system is affected, leading to allergy. Consequently, the
essential filtering function of the nose becomes less and less efficient and pollutants eventually reach more easily the larynx and the lower airways where the same toxic effects are produced. Even the ear may become affected when the mucosa of the tuba is altered and ventilation of the middle ear becomes impaired. Children are innnocent victims of pollution, and studies in Australia, New Zealand, Switzerland and Wales indicate that there is a higher prevalence of allergy, asthma and wheezing in children now than there was 15–25 years ago. As you can understand, the problem is complex and far from being solved: field investigations all over the world, experimental research, clinical, laboratory and functional studies are needed not only to know more but furthermore to provide evidence to health authorities on the growing danger of poisoning our atmosphere and to force them to take measures for prevention. Six years ago, representatives of 172 nations, including 108 heads of state, met in Rio de Janeiro to discuss and tackle the problem of pollution: grand-sounding statements of principle and noble declarations were followed by the presentation of plans of action and the signing of agreements: a better world beckoned. Five years on, when the second world summit, called Rio Plus Five, met in summer 1997 in New York, those present could only register the failure of most of these goals. In fact, industrial countries had to admit that all the Rio targets had been missed. To name but a few: whereas Rio had set a target of returning carbon dioxide emissions to 1990 levels, today’s levels are steadily increasing, not only in developed countries, but China’s emissions will very likely exceed those of the USA by 2005; safe drinking water is not accessible to 20% of the world’s population; and in the Amazon alone an area more than twice the surface of Belgium has been deforested. Dirty industries have not been stopped or controlled and car fume levels are continuously increasing. Not only has little been done to improve our global situation of pollution and practically nothing to fight poverty (the world’s poorest 20% enjoy—a tragic irony—only 1.1% of global income
R. Fior / Int. J. Pediatr. Otorhinolaryngol. 49 (1999) S253 – S255
as compared to 2.3% in 1960), but fossil fuel and transport multinational industries have been working to challenge the scientific evidence for climate change and have influenced the Kyoto
.
S255
conference of last December. Industrialized countries, in an unholy alliance with poor countries rich in natural resources, are set at minimizing these vital issues.