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INFLUENCE OF ADVERSE FACTORS OF MILITARY LABOR ON ENT ORGANS
The ENT organs are extremely important in the work of a person. Their reliable functioning provides not only an active lifestyle, communication between people, but also the implementation of a number of professional tasks. In connection with the development of military equipment, the functional state of the ENT organs in military personnel is of particular relevance. Fulfillment of official duties in various branches and types of the armed forces (submarine fleet, aviation, astronautics, airborne forces, artillery, border troops, etc.), in special services (chemical, engineering, radar, reconnaissance, etc.) and specialties (radio operators, sonar speakers, divers, etc.) makes high demands on such analyzers as auditory, vestibular, olfactory, as well as barofunction, voice-speaking, swallowing, respiratory, protective and barrier functions.
At the same time, service under the influence of extreme factors can negatively affect the functional state of both the organism as a whole and the ENT organs that are associated with the external environment directly or through receptor formations sensitive to traumatic factors.
Currently, there is practically no military specialty where noise would not be among the leading adverse factors. Moreover, the technical improvement of the armed forces, contributing to a significant increase in combat efficiency, in some cases leads to a further increase in noise level. Studies prove that hearing loss is progressing under the influence of prolonged intense noise. The so-called noise hearing loss develops.
Moreover, intense and prolonged irritation of the auditory system can cause a number of disorders that occur in the central nervous and cardiovascular systems, the state of homeostasis and immunobiological reactivity of the body. Often, people working in conditions of prolonged and rather intense noise - 90-120 dB (tankers, aircraft technicians, minders, etc.) as a result of degenerative-atrophic processes in the central and peripheral parts of the auditory system develop professional hearing loss. This leads not only to a decrease in the combat effectiveness and efficiency of the personnel, but also, in some cases, to disability of people.
The widespread use of explosives in mines (mines, grenades, shells, etc.) in a huge percentage of cases leads to acute acubarotrauma of the auditory system among the victims. Often, barotrauma can develop from the action of an air blast or muzzle wave (artillerymen, tankers, grenade launchers, etc.)
The fighting in Afghanistan and the Middle East showed a high striking effectiveness of explosive ordnance, which accounted for almost 85% of all sanitary losses. Change in the nature of hostilities in local conflicts and the degree of protection of personnel (up to 13% of an openly located manpower is usually located in a combat zone up to 3 km deep, 70% are sheltered in military fortifications, 15% are in lightly armored vehicles, 2% - in armored vehicles) makes significant amendments to the structure of possible sanitary losses when using explosive ordnance. The use of personal protective equipment (body armor, helmets, helmets) dramatically increases the protection of military personnel to mechanical damage from fragments and damaging elements, but does not reduce the damaging role of air shock waves.
From the experience of warfare and military conflicts it is known that amid the difficult general condition of victims of explosive factors, the diagnosis of damage to the auditory system, especially in the early stages after an injury, is very difficult. In this regard, in most cases, damage to the auditory system is either not diagnosed at all (51%) or diagnosed late (26.5%), which leads to delayed therapy and significantly affects the effectiveness of providing qualified care. Such victims develop irreversible pathological processes in the peripheral and central structures of the auditory system, other parts of the brain with the further development of sensorineural hearing loss and disability of the victim (Preobrazhensky B.S., 1944; Temkin Y. S., 1947; Voyachek V.I., 1951; Hoffman V.R., Glaznikov L.A., 1996).
In the military profession, the vestibular system is most closely linked to aviation, astronautics, the navy, landing service, etc. It is on air, space and sea ships that crew members are exposed to accelerations of various intensities. With the accumulation of these accelerations, people with increased vestibular excitability may develop a symptom of motion sickness. Severe vestibulosomatic and vestibular vegetative reactions in these individuals often lead not only to the disruption of the combat mission, but also to disasters.
The development of aviation, marine navigation, land transport has made the problem of motion sickness one of the most urgent in military medicine. Thus, according to statistics, 20% of pilots and cadets of flight schools, 36% of sailors, and up to 80% of airborne assailants are subject to motion sickness.
Currently, there are two forms of manifestations of motion sickness:
1) explicit - with severe symptoms;
2) hidden - with a disguised current.
Moreover, according to a number of researchers, about 30% of aviation accidents or prerequisites for flight accidents occur as a result of the development of a latent form of motion sickness among pilots.
With an obvious form, a person suffers severely, experiencing severe dizziness, palpitations, cold sweat, nausea and vomiting.
He becomes completely helpless. Its performance and combat efficiency sharply fall, its operator functions are violated. It should be remembered that factors contributing to the development of motion sickness are: unfavorable sanitary and hygienic conditions of the human environment, features of the constitutional type of person and the nervous system; altered functional state of organs, systems and the whole organism; condition after acute illnesses, as well as chronic diseases.
The airways of the ENT organs are extremely sensitive to pressure differences. So the threshold for sensing fluctuations in the external pressure of the middle ear is 1 - 5 mm Hg. Art. Even with a slight violation of the drainage function of the auditory tube or the mouth of the paranasal sinuses, pressure drops can cause barootitis and acute paranasal sinusitis. Of the paranasal sinuses, the frontal sinuses are most sensitive to injuries, the communication of which with the nasal cavity is through a long and narrow channel. Barotrauma of ENT organs can occur both in peacetime and in wartime among specialists of many military professions: pilots, submariners, divers, caissons. Often, barotrauma can develop from the action of an air blast or muzzle wave (artillerymen, tankers, grenade launchers, etc.)
It is impossible not to take into account the harmful effects on the ENT organs of such occupational hazards of military labor as sources of radioactive radiation. When irradiated in the midst of radiation sickness, the mucous membrane of the larynx, pharynx, oral cavity, nose becomes dry, anemic, loose, bleeding, which ultimately leads to ulceration and necrosis. In such cases, in some cases, hearing loss develops as a type of disturbance in sound perception (due to degenerative processes of the receptor apparatus of the cochlea and auditory nerve). An increased excitability of the vestibular system appears. Such persons are not able to perform operator functions, especially under the conditions of exposure to the body of vestibular loads (flight-lifting personnel, sailors, drivers, etc.). Moreover, at the height of the disease, transportation of such a contingent is extremely difficult, since the development of the symptom complex of motion sickness aggravates their condition.
The use in the Armed Forces of equipment and facilities that study electromagnetic fields (including radio waves) of a different range (microwave, microwave, alternating magnetic and electric fields) is often the cause of occupational diseases. Against the background of the effects of such occupational hazards, profound biochemical changes occur in the tissues of the body, which also in turn violate the functions of the ENT organs and many physiological functions of the body, including the cardiovascular system, immunity, the gastrointestinal tract, and the central nervous system. Such victims have neurasthenia, sleep disturbance, headaches, emotional and somatic discomfort, impaired intracranial hemodynamics, tinnitus, and also vestibulo-vascular insufficiency. These disorders can cause impaired coordination and operator functions, lowering the thresholds of vestibular excitability. In such victims, vestibular dysfunction often proceeds as either a lesser-like or diencephalic syndrome, which is believed to occur due to discoordination of the centers of the brain. Ultimately, in some cases, the disease leads to profound disability of the military serviceman (including due to the development of their oncological diseases). Such radiation is most often exposed to personnel serving radar stations (coast guard, air defense service, radio technical service of the army, aviation and navy, border guard). It should be noted that personnel exposed to such stations are also exposed to such radiation.
Severe dysfunctions of the ENT organs can develop when exposed to various chemicals. Chemical trauma in military personnel can occur both in peacetime (at enterprises, especially the chemical industry), and in wartime (chemical warfare agents). With prolonged exposure to the mucous membrane of such widespread industrial and household chemicals as chlorine, fluorine, aluminum, formalin, manganese and others, a chronic pathological process can develop - atrophic rhinitis, laryngotracheitis and bronchitis with subsequent respiratory distress, barrier functions of the mucous membrane of the upper respiratory tract , destruction of the nasal septum, the development of anosmia, dysphonia. The auditory nerve (quinine, chlorine, iodine) is highly sensitive to certain chemicals, and when exposed to it, acute or chronic sensorineural hearing loss can develop.
Despite the reduction of chemical weapons, the study of the characteristics of damage to the body as a whole and ENT organs in particular with toxic substances remains relevant. These include: OM of general toxic effect (FOV, cyanides), OM of skin-boiling effect (mustard gas, lewisite), tearful OM, asphyxiating OM (phosgene, chlorine), irritating OM, etc.
Thus, a number of harmful factors in the conditions of military service can adversely affect the state of ENT organs. To a large extent, the prevention of the progression of pathological processes developing in military personnel depends on the part physician. A properly organized military medical examination and professional selection will not only support the combat effectiveness of the military contingent, but also prevent the development of serious complications.
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INFLUENCE OF ADVERSE FACTORS OF MILITARY LABOR ON ENT ORGANS
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