Author/Editor		Fajdiga, Igor
Title		Motnje prezračevanja zračnih prostorov glave
Translated title		Disorders of ventilation of the air-filled cavities in the head
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 11
Publication year		2000
Volume		str. 99-103
Language		slo
Abstract		When a person ascends a hill, the air-filled cavities in the body are affected by the change in air pressure. Such cavities in the head - paranasal sinuses and the middle ears lined with temporal bone cells - can adjust to such changes only if their ventilation and clearing (drainage) is unobstructed. Many diseases as well as inborn or acquired nasal abnormalities which impair ventilation and drainage can cause severe health problems to mountaineers. It is not even necessary for the underlying causes to be pronounced at isobaric conditions, since such people would not even go to the mountains and alpinists are not expected to have such problems. They may become manifest only at a change in the atmospheric pressure. Disorders of ventilation and drainage trigger a characteristic pathophysiological process in the air-filled cavities, which is identical to that in the ears and paranasal sinuses. Absorption of gases into the mucosa causes hypoxia, hypercapnia and pressure drop in the cavities. A decrease in pressure results in the accumulation of tissue fluids (hydrops ex vacuo) in the cavity; mucus as well cannot be drained due to obstructed passages, and is accumulated. The material which is accumulated in the cavities is an ideal culture medium and if bacteria are present, purulent infection will quickly ensue leading to the associated severe complications. Difficulties which arise due to disturbed ventilation are so obvious and easily recognizable that they should not be a problem either for general physicians or for mountaineers, if they are appropriately warned. During the early phases, it is difficult to objectively verify disturbed ventilation in the ears and paranasal sinuses and one can only infer about them based on the patient's subjective symptoms. Later, an otorhinolaryngological examination will reveal the characteristic pathological changes and their causes. (Abstract truncated at 2000 characters)
Summary		Pri vzponih v hribe deluje na zračne prostore v telesu sprememba zračnega tlaka. Zračni prostori v glavi - obnosne votline in srednji ušesi obdani s celicami senčne kosti - se ji lahko prilagajajo, če je le njihovo prezračevanje in čiščenje (drenaža) neovirano. Številna bolezenska stanja kot tudi prirojene ali pridobljene anomalije v nosu, ki to prezračevanje in drenažo ovirajo, pa lahko hribolazcu povzročijo hude zdravstvene težave. Ni nujno, da so vzroki v "izobaričnih" razmerah očitno izraženi. Takih pri alpinistu niti ne pričakujemo, saj se z njimi verjetno v gore niti ne bi podal. Lahko se pokažejo šele pri spremembi atmosferskega tlaka. Motnje prezračevanja in drenaže sprožijo v zračnih votlinah značilno patofiziološko dogajanje, ki je enako v področju ušes in obnosnih votlin. Zaradi resorbcije plinov v sluznico pride do hipoksije, hiperkapnije ter padca tlaka v votlinah. Posledica znižanega tlaka je zbiranje tkivne tekočine (lat. hydrops ex vacuo), zastaja pa tudi sluz, ki se zaradi zaprtih prehodov ne more izločati. V votlinah zbrana vsebina je idealno gojišče in ob prisotnosti bakterij lahko hitro pride do gnojnega vnetja in z njim povezanih hudih zapletov. Težave ob nastopu motenj prezračevanja so tako jasne in prepoznavne, da ne bi smele biti problem za splošnega zdravnika in tudi ne za alpinista samega, če je nanje le opozorjen. V zgodnjih fazah je motnje ventilacije v ušesih in v obnosnih votlinah težko objektivno potrditi, nanje sklepamo le iz subjektivnih težav prizadetega. Kasneje z otorinolaringološkim pregledom ugotovimo značilne bolezenske spremembe in tudi vzroke zanje. Motnje prezračevanja je bolje preprečiti, zato naj se v gore odpravijo le zdravi! Takoj ko se pojavijo, jih je mogoče hitro in enostavno odpraviti, kasneje pa je ponovna vzpostavitev prezračevanja zračnih prostorov lahko težja. Seveda ne smerno pozabiti prepoznavanja in zdravljenja osnovnega vzroka zanje, za kar pa je potrebna otorinolaringološka obravnava.
Descriptors		MOUNTAINEERING PARANASAL SINUSES PARANASAL SINUS DISEASES OTITIS MEDIA EAR, MIDDLE ALTITUDE BAROTRAUMA