Acute and Chronical Deseases of the Nose Cavity

8/12/2019 Acute and Chronical Deseases of the Nose Cavity

1/37

Acute and Chronic Diseasesof the Nasal Cavity


2/37

Deviation of the NasalSeptum

natural or acquired persistent displacement

of bone or cartilage structures of the nasal septum,

accompanied by a breach of nasal breathing


3/37


spine of the nasal septum


4/37


Surgical Treatment

Submucosal resection of the nasal septum.

The essence of the operation is

subperichondrial-subperiosteal removing

the curved sections of cartilage and bone skeleton

of the nasal septum

in order to expand the nasal passages

and improve breathing through the nose.


5/37


Complications of submucosal resection

of the nasal septum:

Perforation of the nasal septum

Synechia connective tissue bridge

between the septum and lateral wall

of the nasal cavityAtresia - congenital or acquired imperforate

of nasal passages


6/37

Hematoma and abscess of thenasal septum

Hematoma of the nasal septum- traumatic or spontaneous

accumulation of blood between

the perichondrium and cartilage (periosteum and bone)of the nasal septum.

Abscess of the nasal septum occurs at 4-7 days

after the injury, which led to the formation

of a hematoma of the nasal septum


7/37

Nosebleeds (Epistaxis)Outflow of blood from a blood vesselin violation of the integrity orpermeabilityof the walls of a blood vessel.

Nosebleeds can be:traumaticsymptomatic

slight epistaxis (some ml)mild bleeding (200ml)


8/37

Nosebleeds (Epistaxis)

Treatment

application of vasoconstrictors

cauterization of a bleeding vessel silver nitrate solutionelectrocoagulation of bleeding vessel

detachment of the mucous membrane

in the zone of Kisselbakh

anterior tamponade of the nasal cavity

posterior tamponade of the nasal cavity

transmaxillaroperation on the ethmoidal labyrinthligation of the external carotid artery


9/37


Treatment. Anterior Nasal Tamponade


10/37


Treatment. Posterior Nasal Tamponade


11/37

Acute RhinitisFocus of acute infection in the nasal cavity,

one of the most common inflammatory diseasesof the mucous membrane,

causing a violation of its function.

Three stages of acute rhinitis:

I stage (stage of dry irritation)

II stage (stage of serous discharge)III stage (stage of mucopurulent discharge)


12/37

Acute RhinitisTreatment

I stage:topical symptomatic preparationsbinders and overlying drugs

II stage:insufflation of antibioticsvasoconstrictor drugs

physiotherapy

III stage:bindersantimicrobialsphysiotherapy


13/37

Acute Rhinitisin infectiousdiseases (specific rhinitis)

flu- often epistaxis

diphtheria- dirty-gray film on the mucous membrane

of the nasal cavityscarlet fever- profuse nasal discharge, severe headache,

a characteristic finely dotted rash

on the neck face and bodymeasles- small white spots, surrounded by a red rim

(symptom of Belsky-Filatov)

syphilis- fever, thick yellow-green nasal discharge


14/37

Chronic Rhininis

Rhinitis chronica is a nonspecificinflammatory-dystrophic process of the mucoustunic of the nose that in some cases spreads tothe cartilages and the nasal bones.

The inflammatory process in the mucous

tunic of the nose is the response to theinfluence of the various harmful factors of theenvironment which exceed the protectivemechanisms of the mucous tunic and cause its

inflammation.


15/37

The Main Forms ofChronic Rhinitis

1. Chronic catarral rhinitis (rhinitis cataralis chronica).2. Chronic hypertrophic rhinitis (rhinitis chronica

hipertrophica).

a. Cavernous (false);

b.Fibrous (true);3. Chronic atrophic rhinitis:

a. Simple chronic atrophic rhinitis (rhinitis atrophicasimplex);

b.Fetid chronic atrophic rhinitis or ozena (ozaena);

4. Vasculomotor rhinitis:

a. allergic form (seasonal and constant);

b.neurovegetative form.


16/37

The Causes Of Chronic Rhinitis

professional harmfulness (dust, fumes, gases,chemical substances, inhalation allergens)

unfavorable environmental factors (temperature

contrasts, dryness and air humidity, radiation

background)

domestic and food factors (smoking, narcotic

substances, alcohol abuse, spices, strong tea, coffee,

invariable nutrition, products with the low content ofthe iodide substances, the deficiency of the vitamins

of the groups A, B, D, K)

frequent virus respiratory infections

improper treatment of acute rhinites


17/37

The Causes Of ChronicRhinitis

chronic inflammation of the paranasal sinuses and

the pharynx

long reception of some medical drugs

general diseases (, neurosises, , endocrinedisorders, diseases of the kidneys and the liver, of

the gastrointestinal tract)

hereditary and constitutional preconditions(malformations and the defects of the nose)

domestic and surgical traumas of the mucous tunic

of the nose


18/37

Chronic Catarral Rhinitis

1. Obstructed nasal breathing

2. Poor mucous discharges from thenose (rhinorrhea)

3. Alternation of the stuffiness of the

halves of the nose (more often atnight)

4. Periodic hyposmia

Clinical picture


19/37


20/37

interpretation and elimination of the causeof the disease

strengthening of the organism training of the vasculomotor processes

(nasal shower and pneumomassage)

Mucosa greasing by the astringentsQUV and helium-neon laser endonasal

UHF and microwave therapy

Treatment

Chronic Catarral Rhinitis


21/37

Chronic Hypertrophic Rhinitis

obstructed nasal breathing

smell disfunctiondisorder of the resonator function of

the nose

Clinical picture


22/37


Rhinoscopic picture

Increase of the volume of the mucous tunic of thenasal conches (hyperplasia or hypertrophy)


23/37

1. Cauterisation by the chemical substances (nitratesilver, trichloroacetic and chromic acids);

2. Ultrasonic decomposition;3. Submucous vasotomy;

4. Laser destruction;

5. Cryolysis;

6. Galvanocautery;

7. Removal of the front and back ends of the

inferior nasal conchas;

8. Turbinotomy

Treatment



24/37

Operations in Hypertrophic Rhinitis

inferior turbinotomy

the removal of thehypertrophied part of theback end of the inferior

nasal concha


25/37

Submucous vasotomy of the inferior nasal concha:

a) the lines of the incision on the frontal edge of the concha

b) the line of the acute raspatory (xyster)

Operations in Hypertrophic Rhinitis


26/37

Chronic Atrophic Rhinitis

1. Dryness in the nose

2. Formation of crusts

3. Decreasing of the sense of smell

4. Obstruction of the nasal breathing

because of the crusts5. Nasal bleedings connected with the

atrophic process in the area of the nasal

septum

Clinical picture

The process is caused by the degenerate changes of

the cilliary epithelium

Ch i A hi Rhi i i


27/37

The crusts covering

the mucous tunic The mucous tunic

is "varnished", thin, dry

Enlarged nasal meati

Microtraumas

in Kisselbakh region

Rhinoscopic picture

Chronic Atrophic Rhinitis


28/37

Ozena (Ozaena)

The causes of the development of thediseaseKlebsiella ozaenae (the bacillus of Levenberg-Abel)

Hereditary factors (the predisposition to thedevelopment of the atrophic process in the mucous tunic

of the nasal cavity is inherited).

Hypothalamic disorders, neurotrophic disorders.

Endocrine disorders (disfunction of the sexual glands).

Avitaminosis (the vitamins of the groups A, B, D, K).

Iron deficiency anemia.


29/37

Atrophy of the mucosa and theosteocartilaginous skeleton.

Unpleasant "fetid" smell from the

nose. Abundance of the crusts

obturating the nasal meati.

hyposmia or anosmia.

Clinical picture

Metaplasia of the ciliary epithelium into the

flat one with the atrophy of the adjacenttissues occurs.

Ozena (Ozaena)


30/37

The general treatment:

drugs of iodine, iron vitamins of the groups A, B, D, K

biogenic stimulators (extract aloe,

Gumisolum) in ozena - antibiotic therapy (drugs

that can influence Klebsiella)

Treatment

Chronic Atrophic RhinitisOzena (Ozaena)


31/37


32/37


33/37

Vasculomotor Rhinitischaracteristic allergic form neurovegetative form

the cause Allergen

Disfunction of thevegetative nervous system,vascular and secretorydisfunction, often occursafter acute viralrespiratory infection

allergologicalanamnesis

yes no

general vegetative

disordersno yes

Sensitivity to thecooling, to thechange of thebarometric pressure

Not typical Typical


34/37

characteristic allergic form neurovegetative form

The peculiarities

of the clinicalcourse

Fits of sneezing,stuffiness in the noseabundant liquidtransparent

discharges, reddeningof the face,conjunctiva,lacrimation,impairment of thesense of smell

stuffiness in the nose,dryness in the nose,aggravation of the nasal

breathing in a stuffy roomand in horizontal position,impairment of the senseof smell

rhinoscopyEdema, light pink(almost white) colourof the mucosa.

The nasal conchas areenlarged, of cyanoticcolour, cyanotic- whitishspots ofV. G.Vojachek

Vasculomotor Rhinitis


35/37

characteristic allergic form neurovegetative form

The effect of thevasoconstrictivedrops

Indistinct Distinct

In the periodbetween fits

The mucosa hasnormal appearance.Polipuses can be

present

Severe and long clinicalcourse of acute rhinites

eosinophiliaIn the dischargesfrom the nose and

bloodNot typical

Vasculomotor Rhinitis

h f l h


36/37

The treatment of vasculomotor rhinitis

Allergen elimination.

Sanation of the upper airways and theoral cavity.

Restriction of the use of thevasoconstrictors.

Specific desensibilization.

Non specific hyposensitization:antihistamine, aminocapronic acid,corticosteroids, histoglobulin, calcium

drugs.

Allergic form

Th t t t f l t hi iti


37/37

Normalisation of the reactivity of the nervous system, sleep- tranquilizers, bromine, valerian, motherwort (Leonurus).

Restoratives and tonics: vitamins of the groups A, B, C,nicotinic acid, calcium pantothenate, rutin, biostimulants.

vegetotropic drugs - belloid, bellaspon, bellataminal. immunomodulators - immunal, ribomunil, thymalin.

Reflex therapy: novocainic blockage, acupuncture, reflex-segmentary physiotherapy.

Helium-neon laser. Ultrasonic destruction.

Galvanocautery.

cryotherapy.

N t f th idi

Neurovegetative form

The treatment of vasculomotor rhinitis

Documents

Acute and Chronical Deseases of the Nose Cavity