Assoc. Tsolo Tsolov is a national consultant on ENT diseases and head of the Children's ENT Clinic at Tsaritsa Joanna - ISUL. His research interests are in the field of pediatric otorhinolaryngology, ENT emergencies, extraction of foreign bodies from the respiratory tract and esophagus, dysphagia and esophageal burns with acids and bases.
Prof. Tsolov, do you have many patients this season?
- 75% of examinations in Bulgaria are currently for patients with diseases of the ears, nose and throat. All infectious diseases in children begin with a runny nose, cough, sore throat - scarlet fever, smallpox, mononucleosis. The same goes for any flu-like illness. The flu starts suddenly with these symptoms. Other times a person drags around like a beaten dog for 2-3 days and is finally forced to lie down. So far, there is no declared flu epidemic in Sofia, but when a patient came to operate on him, the next day he said that his throat was scratchy, that he had sneezed during the night. Such a person cannot have his tonsils removed, his polyps removed, or his sinuses operated on, because he is sick with something similar to the flu. He cannot be given general anesthesia if he has a catarrh of the upper respiratory tract. An intubation under general anesthesia in itself irritates the trachea, the mucosa can be scratched and an infection can start from there. Now we also have quite a few pneumonias with emphysema, especially in the elderly. Their lungs retain sputum and fluids, they cannot cough normally. For the elderly person, pneumonia is a very serious disease, sometimes fatal. We specialize in severe pediatric pathology as well as throat carcinomas in adults. My activity is related to the removal of foreign bodies from the respiratory tract and esophagus.
Are these cases many?
- Every week. The problem is really serious, because about a hundred children die at home from foreign bodies in the respiratory tract. Babies with two teeth in their mouths are given seeds, peanuts. The other day we had such a case again, and it was a child of a cultured family. They explained to me that the baby loved peanuts, but choked. Finally, we removed two pieces of peanut from the right upper bronchus. Good thing they came on time, because they are from Sofia after all.
And what about the children from the countryside?
- Children come to us from Lovech, from Pleven, even from Tutrakan and Silistra, because in some places there are no specialists in the extraction of foreign bodies. Colleagues withdrew from this work. The old cadres are no longer there - they were retired without replacing them with others, and this front was laid bare. Earlier, they took out foreign bodies and colleagues in Blagoevgrad, in Kyustendil. They are gone now. And young doctors cannot deal with this right out of university. These things are not taught in textbooks. Apprenticeship in medicine.
Do you at least have equipment?
- Now each hospital is left to fend for itself. We have the most modern devices from 2007. We received them from the "Bulgarian Christmas" campaign thanks to the then president and Prof. Kunev, who told him that it is not normal to remove foreign bodies from children with devices purchased back in the 30s the years of the 20th century.
Part of our equipment was so old
and depreciated. We resoldered some of the brass pipes with tin, but the tin melted from the sterilizations. That and the 2007 endoscope is now obsolete. Medicine is constantly evolving.
What do you usually get out of people's respiratory system?
- Anything you can think of. Here we have a whole collection of objects - plastic toy parts, coins, flat batteries, badges, dentures, dental pins, needles. We are proud of several cases: we saved three infants who swallowed safety needles. With the safety pins, their parents tied an anti-lesson rag to the pram or to the bin or to the sleeve of the shirt. The baby grabs the rag, eats it, but the needle remains in the throat or esophagus and must be removed. Because she is like a fishing hook. Most often, safe needles are swallowed open. This is very dangerous. I take them out, and Prof. Drebov from the children's surgery at "Pirogov" stands by me just in case, because this is a deadly job. If the esophagus bursts, Prof. Drebov and his team immediately start operating. We have many cases of swallowed sharp objects that are also difficult to remove from the esophagus. We have also found such things in the respiratory tract.
What is the danger if a battery is swallowed?
- A quality computer battery, for example, is as big as a 50-cent coin. In an infant or small child, it cannot enter the esophagus, but gets stuck at the beginning of it. The child tries to vomit, cannot drink water, cannot eat. The other problem is that the battery performs electrochemical combustion. Saliva is a good conductor, and if a newer battery has been swallowed, it has a high current. It's like working with an electric knife in this part of the esophagus. Necrosis occurs, burning of the tissue, and quite quickly. If the battery is old and exhausted, sodium or potassium base flows inside.
Like caustic soda burns you
Corrosive liquids for cleaning floors and toilets do the same damage. The new preparations have a relatively nice smell and fruity taste. The children like it, touch the bottle and lick the cap. And that's enough to do significant damage.
What are the lesions of the esophagus and oral mucosa?
- Cruel. If he survives, a long recovery period follows. The affected parts of the mucosa are replaced by connective tissue and the esophagus begins to close. If the child is not treated by the thirtieth day, the esophagus can be completely blocked. Severe surgical interventions followed, the mucosa was replaced with an intestine. But sometimes that doesn't work either. We doctors are not magicians. We often don't even get help from the parents, who keep silent about what exactly happened to their child.
If acid or base gets into the esophagus, what should be done immediately?
- Until the problem is solved in a medical facility, in case of ingestion of acids, rinses are made with bicarbonate of soda, with fresh milk, with egg white. In case of a burn with a sodium base, antidotes are milk and slightly acidic solutions - diluted lemon juice or diluted vinegar, also activated carbon.
Why do such incidents with children happen so often?
- Because the parents don't care enough for them or they are primitive people. We had a recent case from Montana. The grandmother chews on a peanut wafer and gives the chewed to the infant with all the bacteria that live in an adult's mouth. But the worst thing was that the baby choked on a peanut. What prevents the grandmother from making a mess for him! There may be no money for Humana, but at least there is for flour and yogurt. We are simply witnessing a low household culture.
Sometimes cultured people, well dressed, with correct Bulgarian, drop their children. I hope parents show more responsibility and desire to self-educate.