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For the day Вторник, Апрель 28th, 2009.

CASE STUDY: BEHAVIOR PROBLEMS, HEARING LOSS, AND HYPERACTIVITY

David Hart was eight years old when he was brought to me. His problems were obvious: his face was never at peace, but was wracked by spasms; he was continually sniffing, blinking, and squinting. His eyes were red and rimmed by dark circles. Although his grades were average, he had frequent temper tantrums at school and at home.

In addition, David had a hearing problem, which seemed to increase as he grew older. He complained of a ringing in his ears, a condition called tinnitus. This had been unsuccessfully treated with decongestants and antihistamines. Sometimes he complained of having a «bug in his ear.» The slightest noise in class distracted him, since then he could no longer hear the teacher distinctly.

The routine five-day water fast in the Ecology Unit worked wonders: the mouth tic, eye-blinking, and hyperactivity disappeared. So, too, did the bags under the eyes, which are called «allergic shiners,» a frequent sign of food or chemical susceptibility.

When single foods, known not to have been significantly contaminated with chemicals, were returned to David’s diet, some of them brought on attacks of spasms and facial contortions. The worst offenders in his case were wheat, beef, corn, and blueberries, followed by haddock, cherries, peanuts, and potatoes.

Many foods, however, could be eaten without causing any symptoms, such as crab, chicken, pork, lamb, and onion. When some of these acceptable foods were given to David in their commercial, supermarket form, however, they caused grimaces, hyperactivity, eye circles, and gassiness. The boy became progressively more grouchy and twitchy after the second feeding of «normal» food, and this increased with each subsequent feeding. The avoidance of such foods paved the way for David’s recovery, and the last time I spoke to his family, he was greatly improved and doing well in school.

Like Paul Rossi, David was one of those hyperactive children whose problem was actually caused by a highly individualized reaction to the food and chemical environment, and greatly helped by avoiding those items to which he was allergic.

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THE BASIC CONCEPTS OF ALLERGIES: INDOOR AIR POLLUTION

It may have occurred to the reader that air pollution plays a role in the problem of chemical susceptibility. This is true, but not in the way most people suspect. For while it is true that outdoor, or ambient, air pollution is a significant source of exposure, a far greater threat is posed by the presence of indoor, or domiciliary, air pollution.

Indoor air pollution? The term itself is unfamiliar and strange to most people, who tend to think of air pollution solely in terms of smog. Yet the home itself generates combustion products or is directly exposed to them, and many household products give off noxious fumes.

Indoor air pollution is particularly dangerous because exposure to it is so constant. Outdoor air pollution comes and goes; indoor pollution is ever-present, and thus its effects generally remain well hidden. In this it obviously resembles food allergy: as has been explained, allergy to uncommonly eaten foods is readily detected; the real danger comes from allergy to the ordinary foods which we take for granted.

My involvement with the problem of indoor air pollution dates from my earliest chemical-susceptibility cases. In the case of Nora Barnes, for instance, pine paneling and other pine products were implicated as a source of chronic illness. In Ellen Sanders’ case, natural gas and pesticide spray resulted in asthma, arthritis, and a host of other complaints. Removal of these pollutants has resulted in her enjoying reasonably good health over a twenty-five-year period.

I first discussed the topic of indoor air pollution in a series of articles published in 1961 and then in my book, Human Ecology and Susceptibility to the Chemical Environment (1962). Shortly afterward, the topic became a matter of public debate. In 1962, the government called a conference on air pollution, the first of its kind, in Washington, D.C. As often happens with such conferences, the program and speakers’ list were announced first, and then the public was invited to attend. Out of a three-day program, only one-and-a-half hours were allocated for open discussion. During the discussion, I rose to say how astounded I was that no reference had been made, in three days of speeches, to indoor air pollution as a separate topic. In my clinical experience, I added, indoor air pollution was eight to ten times more important as a source of chronic illness in susceptible people than ambient air pollution. Outdoor air pollution, I told the gathering, tended to be intermittent and variable, while indoor air pollution was constant. This very constancy made it a source of chronic disease. And of the various materials found in the home, the gas kitchen range, I said, was easily the worst offender. This left some of the experts without words, but on the far side of the room a gentleman rose and confirmed what I had said, adding some telling details of his own. He introduced himself as Francis Silver. He was an engineer from West Virginia, and later became a member of the Society for Clinical Ecology. We had never met before, but he and I had come to almost identical conclusions about the danger of indoor air pollution, as the result of very different experience—he as an engineer of buildings and I as a clinician studying the effects of such buildings on individual health.

In the following years, there were two conferences devoted solely to the topic of indoor air pollution. In general, these were productive, and I spoke at both.

Since the early 1950s, the extent of the problem of indoor air pollution has continued to grow larger. At the present time, it represents a major source of chronic illness among susceptible individuals in the United States. This can be best understood by considering the kinds of exposures which most frequently result in such chronic health problems.

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CHILDREN’S HEALTH: DRAINING EAR

A draining ear occurs when any abnormal discharge or fluid comes out of the ear canal. The only material that normally comes from the ear canal is wax (cerumen). Earwax is ordinarily brown, though it may be beige or even yellowish if mixed with water when bathing, showering, or swimming. Normally, earwax has only a mild odor, contains no blood, and never flows out in large amounts.

Any other material discharging from the ear canal signals a potentially serious condition. It may be a symptom of a middle ear infection; a boil in the ear canal; swimmer’s ear (infection of the ear canal); rupture (break or tear) of the eardrum by injury or infection; a foreign object in the ear canal; tumour of the middle ear (cholesteatoma); or fracture of the base of the skull.

Signs and symptoms

Abnormal discharge from the ear may be thin and watery, bloody, odorous, cheesy, green, yellow, or white.

Home care

Any drainage from the ear canal (except typical earwax) should be considered abnormal. Do not try to treat a draining ear at home. It should be promptly seen by a physician.

While waiting to see the doctor, pain accompanying a draining ear may be temporarily treated with aspirin or paracetamol pain relievers.

Precautions

• A draining ear should be examined by a doctor within 12 to 24 hours.

• Do not pack cotton into a draining ear. Packing the canal may force the discharge back into the middle ear.

• Do not use a cotton swab or any other instrument to remove material still in the canal.

• Do not attempt to wash out a draining ear since the eardrum may be broken or torn.

Medical treatment

Your doctor will gently clean your child’s ear, inspect it, and diagnose the cause. Depending on what is found in the ear canal, treatment may require oral antibiotics, medicated ear drops, removing a foreign body, an X ray of the child’s skull or mastoid bone, or surgery for cholesteatoma (tumour of the middle ear). In the case of a ruptured eardrum, antibiotics may be required for a long time, until the eardrum is healed and hearing returns to normal.

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