It can be divided into infection, hemorrhage, allergy, tumor, trauma, foreign body, congenital malformation and structural abnormality.
The nose is often affected by external adverse factors, and is prone to various diseases.Microbial infection can cause nasal furuncle, nasal vestibulitis, inflammation of nasal cavity and sinuses;The nasal cavity is the gateway for allergens to enter the body and the site of allergic diseases, so pollinosis and allergic rhinitis are common diseases;Some oral diseases such as root infection can cause odontogenic maxillary sinusitis.
The external nose is located in the middle of the face and is vulnerable to trauma. The external nose is an important sign to maintain the correct appearance. Therefore, the surgical requirements for congenital and acquired nasal deformities are high.Nasal cavity and paranasal sinuses are the predilection sites for malignant tumors, with maxillary sinus cancer being the most common, followed by nasal cavity cancer and ethmoid sinus cancer.
The nose is anatomically adjacent to the skull cavity, orbit and mouth. Diseases of the nasal vestibule, nasal cavity and sinuses can lead to serious complications, such as meningitis, orbital cellulitis, etc;Cavernous sinus infection can be caused by blood circulation, which can lead to blindness and even endanger life in serious cases.Classification The classification of nose diseases is shown in the table.
clinical manifestation
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Classification and clinical manifestations of nasal diseases
The main symptoms were mucous membrane irritation and respiratory and olfactory dysfunction.
① Nasal obstruction.The degree of nasal obstruction is different, including complete obstruction, intermittent obstruction and bilateral nasal cavity interactive obstruction.Because the mouth must be opened for breathing when the nasal cavity is blocked, the warming and humidifying effects of the nasal cavity disappear, and pharyngitis, laryngitis, and lower respiratory tract infection are prone to occur.Long term open mouth breathing due to nasal obstruction in children can cause mandibular deformity (recession).
② Increased nasal secretions.Under normal circumstances, the glands of the nasal mucosa secrete 500~1000ml of liquid every day, but either volatilize or swallow, without consciously having rhinorrhea.The nature of secretions can be divided into serous (water like), mucinous or mucopurulent, and rarely bloody secretions.When there is inflammation, foreign body and tumor in the nasal cavity, the nasal secretion increases, but the nature is different.
③ Sneezing.It is a protective reflection.It can expel foreign bodies, microorganisms or allergens entering the nasal cavity from the nasal cavity.It is a common symptom of allergic rhinitis and acute rhinitis.But sneezing can spread infection.
④ The sense of smell declines or disappears.When the nasal cavity has an obstructive disease, odorous molecules in the air cannot contact with the mucous membrane of the olfactory area near the top of the nose, which is distributed at the end of the olfactory nerve, resulting in decreased or disappeared sense of smell.Olfactory neuritis and atrophy of olfactory nerve endings and mucous membrane in olfactory region are also the causes of olfactory decline or disappearance.
⑤ Abnormal phonation.It is caused by the influence of nasal resonance, and occlusive nasal sounds appear when the nose is blocked;Open nasal sounds appear when the soft palate is paralyzed.
⑥ Local deformity.Nasal sinus and nasal cavity tumors can cause deformities of the external nose and corresponding nasal sinus regions, and nasal cavity tumors can cause nasal dorsal distention;Maxillary sinus tumors can cause cheek swelling and hard palate subsidence;Tumors of ethmoid sinus may cause swelling of inner canthus and exophthalmos;Frontal sinus tumors can cause swelling of the forehead and the upper corner of the orbit, and outward and downward displacement of the eyeball.
diagnosis
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In addition to asking about the medical history and physical examination, it mainly includes the following nine items.
① Nasoscopy.Nasoscope is a special metal instrument, which can open the front nostril to check the nasal condition.
② Posterior rhinoscopy.The back of the nasal cavity and nasopharynx were observed with a small mirror. Some patients could not succeed in pharyngeal reflex sensitivity examination, so a small amount of surface anesthetic should be sprayed on the pharynx.
③ Nasal endoscopy and sinus endoscopy.Optical fiber endoscope can be used to examine the nasal cavity, nasopharynx and the interior of nasal sinuses. The endoscope is equipped with magnification and imaging devices, which is of practical value for disease diagnosis and follow-up.
④ Nasal resistance test.The nasal manometer is used to measure the nasal resistance to objectively determine the changes of nasal pressure and flow during breathing. There are two kinds of manometry methods: anterior nasal and posterior nasal.
⑤ X-ray radiography.The nasal cavity and sinuses contain air, surrounded by bone walls, and the X-ray contrast is obvious.X-ray film can be used to observe the pathological changes in the nasal cavity, paranasal sinuses and the surrounding orbit and skull base.Fine lesions can be seen by tomography and paranasal sinus lipiodol (or iodine water) radiography.
⑥ Cytological and histopathological examination.It is one of the indispensable means to diagnose tumors in the nasal cavity and paranasal sinuses, and sometimes the diagnosis of specific inflammation also needs this examination.
⑦ Examination of olfactory function.It can be measured with an olfactometer to detect the ability to distinguish different odors.
⑧ Ciliary function inspection.Observe the time required for granular materials (such as carbon particles and saccharin) and radioactive materials to travel a certain distance on the nasal mucociliary blanket to determine the function of the nasal mucociliary transport system.
⑨ CT examination.It can provide valuable data for the diagnosis of tumors, but has no special application value for inflammatory diseases.In addition, nasal secretion bacteriology examination, systemic and local immune status examination are also commonly used examination methods for nasal diseases.
treatment
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Antibiotics are the most effective treatment for infectious diseases such as acute sinusitis, nasal furuncle, etc;Patients with epistaxis can use vaseline gauze, gelatin sponge, etc. to fill the nasal cavity to stop bleeding, and treat the causes of epistaxis accordingly to prevent rebleeding;Patients with pollinosis and perennial allergic rhinitis should try to reduce the inhalation of allergens (pollen, indoor dust, etc.). Desensitization therapy (immunotherapy) can change the immune state of the body, so as to achieve the goal of no disease or obvious relief of symptoms;Patients with nasal polyps need nasal polypectomy, and chronic hypertrophic rhinitis and structural rhinitis often need surgical treatment.
Plastic surgery for congenital nasal deformity and traumatic nasal defect can not only improve the appearance, but also restore the nasal function to varying degrees.Malignant tumors of the nasal cavity and paranasal sinuses should be extensively resected.Before operation, radiotherapy and chemical drugs (such as cyclophosphamide, vincristine, etc.) should be coordinated according to the situation.
Relationship between nose diseases and systemic diseases
Nasal diseases are closely related to systemic diseases. Systemic diseases can be the cause of nasal diseases, nasal diseases can be the local manifestation of systemic diseases, and some nasal diseases can cause systemic diseases. Therefore, there should be a holistic concept in the diagnosis and treatment of nasal diseases.Some systemic diseases, such as hypertension, arteriosclerosis and hematopathy, are common causes of epistaxis. The treatment of epistaxis caused by systemic diseases is often more difficult than that caused by nasal factors.Some endocrine diseases can affect nasal mucosa, such as systemic mucoedema caused by hypothyroidism, and nasal mucosa also has mucoedema changes, which is clinically manifested as nasal obstruction.Chronic diseases, such as anemia, tuberculosis and liver, kidney, heart and other diseases can cause anemia or congestion in nasal mucosa, which is clinically manifested as chronic rhinitis.Nasal tuberculosis and rhinosyphilis are local manifestations of systemic tuberculosis and syphilis.
Severe nasal trauma is often associated with craniocerebral or systemic trauma.Crushing furuncle may be complicated by infection of cavernous sinus (intracranial venous sinus). Inappropriate treatment of sinusitis may be accompanied by meningitis. Once intracranial complications occur, serious consequences may result, even death.
Allergic rhinitis may occur simultaneously or successively with other type I allergic diseases (bronchial asthma, urticaria, eczema, etc.).Sneezing may be a precursor symptom of anaphylactic shock.The sella turcica operation through the nasal cavity or paranasal sinus can avoid craniotomy, reduce the amount of bleeding during the operation, and have fewer complications, which is safer for patients.The common nasal diseases are rhinitis, sinusitis and epistaxis.Other common diseases are as follows:
① Furuncle and vestibulitis.Nasal furuncles are furuncles on the skin of the nasal vestibule, and the main pathogen is Staphylococcus aureus.At the beginning, it was localized redness and swelling, and in severe cases, redness and swelling could affect the upper lip and cheeks.Hot compress and antibiotics are mainly used for treatment. Do not squeeze furuncles to prevent intracranial infection - cavernous sinus thrombophlebitis. Inappropriate treatment may lead to blindness and death.Nasal vestibulitis is mainly caused by nasal vestibular skin irritation caused by secretions of rhinitis and sinusitis, which is common in children.The skin around the nasal vestibule and front nostril can be seen redness, swelling, scab, etc. The treatment is mainly based on local application of non irritating anti-inflammatory ointment, and the treatment of rhinitis and sinusitis.
② Nasal trauma.It is commonly seen in fights, operations, traffic accidents, etc., mainly including external nose cutting injury, blunt contusion and nasal bone fracture.Serious nasal trauma is often associated with sinus trauma, facial and craniocerebral injuries, and injuries in other parts of the body.The treatment of fresh nasal bone fracture is simple and easy to reset, and the old fracture needs surgery to correct the nasal deformity.There are often foreign bodies in the wound of nasal trauma, so attention should be paid to the treatment.
③ Nasal polyps.It is the result of long-term edema of the nasal mucosa. When the edema reaches a certain degree, the nasal mucosa droops to form nasal polyps.Mucosal edema is caused by allergy or infection.Nasal polyp is a common disease. It has two types: single and multiple, and its appearance is like a peeled white grape.Small nasal polyps have no obvious symptoms, large or multiple nasal polyps can block the nasal cavity, and the main symptom is nasal obstruction.Surgical resection is the main treatment. Patients with multiple diseases often have a tendency to recur after surgery, and those with recurrences can be re operated.Nasal polyps should be differentiated from malignant tumors in the nasal cavity, especially in middle-aged and elderly patients.The removed nasal polyps should be subject to pathological examination to prevent missed diagnosis.
④ Foreign body in nasal cavity.It is mostly seen in children, and the types of foreign bodies are mostly paper balls, beans, fruit stones, etc. The foreign bodies that have been left for a long time can produce a large amount of unilateral, malodorous purulent secretion due to secondary infection.The foreign body can also be used as the core. The long-term survivors can form nasal stones due to calcium deposition. The smaller nasal stones can be removed from the front nostril, and the larger nasal stones need to be removed surgically.
⑤ Nasal tumor.The nasal cavity and paranasal sinuses are the predilection sites for tumors.The common benign tumors include papilloma, osteoma, fibroma, hemangioma, etc. The diagnosis depends on pathological examination and X-ray film, and the treatment is surgical resection.Malignant tumors of the nasal cavity can be divided into two types: those originating in the nasal cavity and those originating in the sinuses that invade the nasal cavity. A mass can be seen in one side of the nasal cavity, with a cauliflower like, nipple like, or polypoid surface. Erosion or ulcers can also occur, so the secretion is bloody.
Malignant tumors of the paranasal sinuses are most common in the maxillary sinuses and least common in the sphenoid sinuses.The early tumor was located in the sinus cavity, without any clinical manifestation, and the late bone destruction resulted in cheek deformity and exophthalmos.The typical clinical manifestations of malignant tumor of maxillary sinus were as follows: when the medial wall of maxillary sinus was destroyed, the tumor invaded the nasal cavity, and the tumor could be seen through nasal endoscopy;Cheek swelling occurs when the front wall is damaged;There was exophthalmos when the upper wall was damaged;When the posterior wall is damaged, it affects the muscles of opening mouth, which is manifested as difficulty in opening mouth;When the lower wall is damaged, the hard palate is distended. If the alveolar is invaded, the maxillary teeth may become loose.
The diagnosis of malignant tumors in the nasal cavity and paranasal sinuses must rely on pathological examination. Cancer (especially squamous cell carcinoma) is more common, sarcoma is less common, and the treatment is based on extensive surgical resection, combined with radiotherapy and chemical drug treatment according to human conditions.
Nasal hygiene
The nose can process the inhaled air and protect the lower respiratory tract, so we should develop the habit of breathing with the nose.The nose is also one of the portals of infection. There are various microorganisms in the nasal cavity. When the skin and mucosa of the nose are damaged, infection is easy to occur.Nose digging is one of the important reasons for the damage of nasal skin and mucosa, so the habit of nose digging should be abandoned.The venous blood in the nose flows into the cavernous sinus in the skull. When nasal infection spreads, cavernous sinus thrombophlebitis and septicemia can occur. Therefore, in case of nasal furuncles, antibacterial drugs should be used in time, and hand squeezing is absolutely prohibited.Nasal infection can cause eustachian tube inflammation, and spread to the middle ear through the eustachian tube, causing otitis media.Nose infections, especially colds, are the most common cause of acute otitis media.One of the important measures to prevent common cold complicated with otitis media is to apply mucosal contractive agent to drip nose to make the secretion in nasal cavity flow out smoothly and reduce the edema of eustachian tube mucosa.
The increased pressure in the nasal cavity can promote the intranasal infection to spread to the middle ear through the eustachian tube, which is easy to happen when blowing the nose. Therefore, when nasal secretions need to be blown out, care should be taken to prevent the infection from spreading to the middle ear.The correct way to blow your nose is to press one nostril with your fingers, blow out the secretion when the opposite nasal cavity is unobstructed, and do it on both sides separately, so as to prevent the pressure in the nasal cavity from being too high.Since nasal diseases may be accompanied by the narrowing of the mouth of the sinuses and the mouth of the pharynx drum tube, and cannot adapt to rapid pressure changes, patients with these conditions should not live and work in an environment with rapid pressure changes, such as aviation, diving, etc.
