THERMAL INHALER

The therapeutic use of thermal waters has been known since ancient times, just think of the thermal culture of ancient Rome and the numerous medieval testimonies of the diffusion and effectiveness of thermal treatments in general and thermal baths in particular.

The applications in ENT are equally ancient and widespread and among these are of essential importance

inhalation treatments.

Inhalation treatments have the aim of introducing suitably divided mineral waters and/or the gases dissolved in them into the body through the upper aerodigestive tracts (VADS) using equipment that exploits the property of a liquid to be separated into very small droplets, such that they can be inhaled.

Aerosol devices are built with this principle: in them a liquid is pushed under pressure into a tube that presents

at its end a bottleneck.

From this bottleneck this liquid comes out explosively, creating a vacuum.

If there is a liquid (thermal water) present in the environment in which the vacuum is created, it is aspirated and crushed

to form a fog.

With particular precautions and flow deviations of this fog it is possible to create droplets of different diameters:

these are called micelles.

Aerosol devices are capable of producing micelles with a diameter between 10 and 3 µ or

less than 3 µ in diameter.

This differentiation allows for different therapeutic use.

Effectiveness of inhalation treatments with sulphurous waters on chronic inflammatory pathologies of the upper aerodigestive tracts.

The larger particles, in fact, are heavier and stop in the VADS (nasal cavities, oropharynx), while the smaller ones,

lighter, they can penetrate the smallest bronchioles.

The thermal treatment technique involves inhalations of these aerosols through the nasal cavities using special fork devices that allow the thermal aerosols to be conveyed directly into the nostrils, or inhalations through the cavity

oral directly from the aerosol equipment.

Inhalation spa treatments are widespread in Italy.

Sulphurous waters act in different ways.

An increase in secretions occurs due to a local vasodilatory action which leads to an increase in capillary permeability.

The sulfur in the water then produces a reduction in the viscosity of the mucus through the lysis of the disulphide bonds of the mucoproteins

contained in it, effectively inducing a fluidification of the secretions.

Another action is that of regulating the motility of the vibrating cilia of the ciliated epithelium of the nasal cavities.

The sulphurous waters also act to stimulate the reticuloendothelial and histiocytic system, through a reduction

of interleukin production by T lymphocytes.

On nasal secretions in particular, the action of sulphurous waters is such as to lead to an increase in immunoglobulins.

Inhalation therapy is also effective due to a non-specific action derived from exposure to moist heat.

This induces a hyperemia of the mucous membranes which causes improvement in trophism and regulation

muciparous activity, increased cell turnover, restoration of ciliary motility; furthermore it causes fluidification of the secretions which allows them to be removed more quickly with a consequent reduction in the possibility of development

of pathogens.

Thermal treatments are indicated in various ENT pathologies.

We limited our study to the effect of thermal treatments in patients with pathologies that can be summarized as: chronic pharyngitis,

chronic pharyngotonsillitis, chronic laryngitis and chronic rhinitis.

Chronic pharyngitis By chronic pharyngitis we mean a process of subacute inflammation of the pharyngeal mucosa.

This can be caused by pathogens, but above all it can be attributed to the effect of the continuous air

inhaled through the mouth.

In this case the filtering, humidifying and warming effect of the air operated by the nasal structures is missing.

This leads to a state of subcontinuous irritation of the pharyngeal structures, also exacerbated by polluting factors

(atmospheric, tobacco smoke, etc.), which causes a hyperplasia of the lymphoreticular structures located widely in the pharynx.

Patients complain of symptoms that could be defined as minor, but annoying: dry mouth, especially in the morning,

pharyngodynia, pharyngeal writhing, cough.