The contribution of thermal cures in ENT

The practice of thermal cures goes back to antiquity.

Since the Roman period and throughout the following centuries, the curists frequented the thermal establishments implanted for the most part in the exact location of the ancient Roman baths. In the XIXth century, inhalations were added, often used in pathologies ENT and we associate the benefits of the water of cure by using it as simple drink.

The first and second Empire were prosperous periods for the thermal establishments, which saw their number increase and their equipment modernize. Plombières-les-Bains was regularly visited by the relatives of Napoleon^I and Napoleon III himself visited this resort more than once, while Eugénie-les-Bains, in the Basque country, was one of the favorite resorts of his wife, Empress Eugénie.

In the 90’s, the spa industry experienced a crisis and saw its attendance drop by 15%, forcing the establishments to adapt by proposing a non-conventional spa, oriented towards balneotherapy, fitness and a more playful spa – without neglecting the cure covered by the Social Security proving, if it were necessary, its indisputable benefit in many areas, the quality of the waters directing the indication.

Let’s mention in a non-exhaustive way its use :

• In dermatology,
• For the respiratory tract,
• For rheumatological diseases,
• For neurological diseases,
• For psycho-somatic affections,
• For cardio-vascular diseases,
• For phlebology,
• Without forgetting, of course, its indisputable benefits for chronic ENT and/or infectious diseases.

We will speak here only about the ENT indications of the thermal cures by briefly detailing the beneficiary pathologies, organ by organ, by specifying beforehand, except in exceptional cases, that the thermal cure always comes as a complement to a medical or surgical treatment whose expected benefit proves to be insufficient.

• Chronic allergic rhinitis

Chronic rhinitis is, by definition, an inflammation of the nose that has lasted for several months, associating a clear or thick discharge or simply a nasal obstruction. These symptoms can be of allergic origin but not always (non-specific nasal hypersensitivity).

Classically, rhinitis is seasonal, triggered by a respiratory allergen that can be investigated.
Symptoms are suggestive of clear rhinitis (the nose runs like water), sneezing, blocked nose associated with headaches, tingling of the eyes… These symptoms are immediately suggestive of an allergic component and the clinical examination reveals, in most cases, a congested nose with a classically “lilac-white” mucosa, sometimes associated with bilateral nasosinus polyposis, which is a sign of an allergic etiology The treatment will be medical in most cases.

In the case of chronic symptoms, thermal waters have their full indication. When there is no superinfection, the patient should be directed to non-sulfurous waters, but sulfated, calcic or sodium waters rich in trace elements. The methods used are based on nasal showers, sonic aerosols, humage and nebulization.

In addition to the local treatments with the properties inherent to the spa water, the environment, the climate and the change in the rhythm of life are also essential in the results expected from the patients. Two to three consecutive cures will be proposed, with an indisputable result on the chronic dysfunction of the nose of the patients and a better-being felt, sometimes from the first cure, but more often from the second.

• Chronic perennial non-allergic rhinitis

For more than a decade, ENT specialists have been confronted with this pathology whose etiopathogeny is poorly understood, perhaps because it has not been the subject of many studies, proof if it were needed of its lack of seriousness if not of its lack of social discomfort.

The patient presents a nasal congestion with a blocked nose, sometimes tilted, one and the other nostril being blocked alternately and often at night depending on the position in which one sleeps. Sometimes a discharge is associated with it, like the typical allergic rhinitis, discharge which can also be triggered when getting up, when changing position while waking up, when moving from one room to another, when eating..

In addition to thermal variations, stress, tobacco, alcohol, obesity and even the wind…. have been blamed for its genesis.

However, let’s not forget (just reread Balzac and his Comédie humaine or look at the caricatures drawn by Daumier) that this pathology was never described 150 years ago. Let us conclude more prosaically that the environment is certainly the essential element in the emergence of this pathology.

In addition to medical treatments that can be similar to those for allergic rhinitis, it is natural to propose cures for these patients, where changes in habits and the environment will be of great importance.

• Allergic sinusitis

This is the next stage of chronic allergic rhinitis. Allergic rhinitis is complicated by allergic sinusitis, the treatment of which is similar to that of allergic rhinitis. Long-term treatment with antihistamines and corticoids depending on the allergens involved, antibiotic treatment of superinfection if necessary, or even surgical treatment which can prove to be life-saving if a well-managed medical treatment is not enough. However, the latter may still not be sufficient despite a well performed surgical procedure and a long term medical treatment prescribed with smoking cessation highly desirable. In these cases, repeated spa treatments can be very beneficial, as the nature of the water can be sulfurous in the case of an additional infection.

• Pharyngitis, laryngitis

Whether caused by chronic posterior nasal discharge (clear or purulent) with its consequences of sore throat, broken voice, we find ourselves in the same cases as before where the terrain, the environment, smoking are major factors and, necessarily, the cures will improve the curists.

Gastroesophageal reflux can give the same symptoms.

Medical treatments of reflux improve but the cure can be a precious adjuvant if we consider, there too, that stress increases them and that smoking increases gastric peristalsis (contractions of the stomach). A change of climate and environment, a stop of smoking will be useful sometimes (nasal irrigation, pharyngeal shower, inhalation, spraying, humming, gargle, drink cure, aerosols, nasal bath…)

• Angina / Tonsillitis

Angina is not the best indication for cures, but it has been proposed, certainly because it can improve the patient.

If it is a child, the indication for a cure is not logical.
Why leave infected tonsils (which are of no use except to maintain the angina) when a surgical cure definitively solves the problem? As for the hypothesis of indispensable organs for the immunization of the child, it has been known for a long time that there are enough lymphoid organs for his immunization and that these tonsils favor infections.

The case of adults can be approached differently, both for angina and tonsillitis.
The surgical intervention is painful (if not dangerous) contrary to the child and one can understand the reluctance to undergo surgery especially since there is no danger if the intervention is refused. We can then propose these cures where, as in the previous cases, the care can allow the evacuation of the caseum on the lymphoid organs, reduce the inflammation and improve the pain and the frequent fever (tonsillitis) or the attacks of angina.

– Acute ear infections / serous ear infections

The otitisare the consequence of a chronic dysfunction of the eustachian tubes which allow to balance the pressures in the tympanic box. As for angina and tonsillitis, the treatment is slightly different for adults and children.

In children, acute otitis (painful and inflammatory phenomenon of the eardrum) is the consequence of a rhinopharyngeal affection and the treatment of the nose and often the operation of the adenoid vegetations generally solves the problem.

It can be different in the case of seromucosal otitis, which are also the consequence of a chronic dysfunction of the eustachian tube. There is a thick slime behind the eardrum that hinders hearing, which can lead to a delay in school. These serous otitis can be complicated by acute otitis in case of reheating of the sero-mucous otitis or sclerosing otitis. In this case, the liquid eventually resorbs, causing retraction of the eardrum onto the ear drum and permanent hearing damage. Seromucosal otitis therefore requires regular monitoring.

If there are large vegetations, we will propose, in a first step, the cure of adenoid vegetations which will be able, with time, to cure the serous otitis. If this is not the case and if the child presents a risk of delay in schooling due to a noticeable decrease in hearing, the beginning of tympanic retraction or repeated acute reheating, trans-tympanic aerators will be associated with the treatment of the vegetations or at the end of the treatment (they allow the reabsorption of the glue and prevent its recurrence as long as the aerators are in place).

In the vast majority of cases, this treatment will be sufficient to cure the child. However, some children with an allergic background or with adenoidal facies (narrow facies) or children with a fragile background (sometimes with an iron deficiency that can be compensated for) continue to have ENT infections and serous otitis when the aerators are removed. It is for these fragile children that repeated thermal cures can be happily proposed, sometimes in hospital. This remains the exception.

What about serous otitis in adults ?

Acute otitis media is very rare in adults and complicates a nasal disorder. It can be treated medically.

Otitis externa is much more frequent in adults and affects the ear canal. It is the consequence, among other things, of untimely scratching (by cotton swabs or not) especially when water stagnates in the auditory canals and it is also treated exclusively by medical treatment and a loss of certain habits.

Seromucous otitis, always a consequence of a chronic dysfunction of the Eustachian tubes, must lead to a search for a problem in the cavum (back of the nose), whether it is a tumor – obstructing the tubal orifices and producing this metaplasia of the cells of the ear cavity with transformation of the ciliated cells into mucus cells due to the absence of ventilation – or a chronic posterior discharge from the nose on a particular terrain and we come back to our chronic perennial rhinitis or even allergic rhinitis for which we have seen the treatment.

However, a tumor of the cavum will first require treatment, just as for chronic posterior catarrh.

It will be, there as elsewhere, the insufficiency of the medicinal results, even radiotherapy, which will make propose, after the treatments adapted to the etiology and possibly the transtympanic aerators, thermal cures identical to the cures for chronic rhinitis.

We have outlined here the essential indications for ENT thermal cures, whether for adults or children.
Of course, this list of ENT spa treatments is not exhaustive, but it is important to remember that spa treatments have existed for at least 21 centuries, developed by the Romans. However, a medicine cannot survive time if its efficiency remains doubtful. Nowadays, in spite of the heavy health expenses, the cures continue to be covered by the Social Security, proof of its effectiveness when the indication is well established.

The thermal medicine of the Thermes Adour

Respectful of the body and non-invasive, the thermal medicine of the Thermes Adour offers a relevant health approach that is not only based on the treatment of symptoms but on the global management of a pathology, giving prevention as important a place as relief. It represents only 0.13% of the Health Insurance budget and has proven its effectiveness over the long term through numerous scientific studies. During a spa treatment, the health care teams provide natural, effective treatments using the thermal waters and mud of Dax, a natural resource whose benefits are recognized by the Academy of Medicine.

What benefits can I expect from a spa treatment? The benefits of a spa treatment are mainly felt in :

• The clear reduction of pain,
• A clear improvement in mobility,
• A decrease in the use of medication,
• The gain of confidence and autonomy during several months.

More information here.

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