Various factors that continuously stimulate the nasal mucosa, affect the ciliary clearance function of the nasal mucosa and increase the respiratory resistance of the nasal cavity can cause chronic rhinitis. Such as long-term work in a polluted environment, contact with harmful gases, dust, etc. ; Or because of repeated attacks of acute rhinitis, the treatment is not thorough; Or long-term improper use of rhinitis essence will cause chronic rhinitis.
It is not difficult to diagnose chronic rhinitis. In the treatment, we should pay attention to avoid harmful factors that cause diseases, strengthen our physique, and choose appropriate nasal drops. For chronic hypertrophic rhinitis, sclerosing agent can be injected into the submucosa of hypertrophic inferior turbinate, or the inferior turbinate can be contracted by laser and cryotherapy, which is beneficial to nasal ventilation and drainage.
prescription
1. Strengthen labor protection and avoid or reduce exposure to harmful gases and dust.
2. When suffering from acute rhinitis, pay attention to rest and active treatment. Pay attention to strengthening physical exercise at ordinary times.
3. Chronic simple rhinitis can use 1% ephedrine nasal drops, and pay attention to mastering nasal drops.
4. Don't use Biyanjing for a long time.
5. The inferior turbinate surgery should be cautious, because excessive resection will induce atrophic rhinitis.
Chronic rhinitis is a chronic inflammation of nasal mucosa and submucosa caused by systemic, local or occupational factors. It usually includes chronic simple rhinitis and chronic hypertrophic rhinitis. The clinical feature of chronic simple rhinitis is that the nasal congestion is alternating and intermittent, and there are many runny noses, often mucus. The clinical characteristics of chronic hypertrophic rhinitis are severe nasal congestion, mostly persistent, less runny nose, thicker nose and difficult to spit out. When chronic rhinitis is serious, it can affect the olfactory function.
Health guide:
1. Increase physical exercise, choose medical exercises, Tai Ji Chuan, Wuqinxi, table tennis, sword dance and other projects, and persevere, which can enhance physical fitness and improve the body's disease resistance. Starting from summer, insist on washing your face and wiping your nose with cold water to increase your cold tolerance. Avoid catching a cold when the weather is cold or the climate changes drastically, and wear a mask when going out. Try to find out the pathogenic factors and prevent them in time.
2. When the nose is blocked, don't blow your nose hard, so as not to cause nasal capillary rupture and nosebleeds, and also to prevent bacterial mucus from entering the nasopharynx and complicated with otitis media.
3. Use the self-nose massage technique, and massage the bridge of the nose at the inner corner of the eye with both index fingers and middle fingers at the same time, from top to bottom 1 time, ***80 times; Rub the middle finger on both sides of the nose about 1 cm, and do rotary massage, ***70 times; Massage the eyebrows with the index finger, middle finger and ring finger of both hands at the same time, and then massage outward along the eyebrows to the two temples, ***60 times. You can massage repeatedly, once in the morning, once in the evening. Can effectively prevent the occurrence of rhinitis and improve the condition of chronic rhinitis.
4. Wash the nasal cavity with warm boiled water, and then apply it to the affected part of the nasal cavity with cotton swab dipped in raw honey, once a day 1 time, until the nasal cavity is painless, no secretion scabs, and the sense of smell recovers.
5. Diet should be easy to digest and absorb. Avoid colds, cigarettes, alcohol, spicy and dry products.
6. Actively and thoroughly treat acute rhinitis.
Chronic rhinitis is a common disease, including nasal congestion and runny nose. Breathe with your mouth when your nose is blocked, and the breathing door is open, which is easy to get sick. Therefore, chronic rhinitis should also be paid attention to and actively treated.
Chronic rhinitis, due to repeated attacks of acute rhinitis and improper treatment, gradually evolved.
Partial lesions such as deviated nasal septum, turbinate hypertrophy and nasal polyps, as well as chronic lesions of adjacent organs, such as people with chronic tonsillitis and sinusitis, are prone to chronic rhinitis. In addition, people who work in dusty, hot and dry environments for a long time, or who are exposed to harmful gases for a long time, and those who lack exercise, have poor adaptability to climate change, and are prone to colds and colds are prone to chronic rhinitis.
Some patients suffer from some chronic diseases, such as heart disease, liver disease, tuberculosis, kidney disease, severe anemia, vitamin deficiency and so on. Because the nasal mucosa is often in a state of congestion or malnutrition, it is easy to be complicated with chronic rhinitis.
Chronic rhinitis usually includes chronic simple rhinitis and chronic hypertrophic rhinitis. The symptoms of chronic simple rhinitis are nasal congestion and increased nasal discharge, often accompanied by olfactory dysfunction and headache. Nasal congestion is mostly intermittent, alternating on both sides. The symptoms of chronic hypertrophic rhinitis are more serious than those of simple rhinitis, with persistent nasal congestion and obvious decline in sense of smell. Hypertrophy of the posterior end of inferior turbinate can compress the pharyngeal orifice of eustachian tube, causing tinnitus and hearing loss. Due to frequent mouth breathing and secretion stimulation, pharyngeal inflammation is prone to occur, and symptoms such as dryness and cough appear. In addition, headache, insomnia, memory loss and listlessness are also common symptoms.
To treat chronic rhinitis, we must first find out the related pathogenic factors in the whole body, local area and environment, and treat or eliminate them in time. Local vasoconstrictors can be used, such as 0.5 ~ 1% ephedrine saline, or nasal drops such as Biyanjing can be used for a short time. Acupuncture therapy can take Xiang Ying, Hegu and other points. Blocking therapy can use 0.25 ~ 0.5% procaine to block the above-mentioned points, and can also be used to block the nasal mound or the anterior mucosa of the inferior turbinate. When the secretion is too viscous to be eliminated, warm saline can be used to wash the nasal cavity. For Lower turbinate hypertrophy, if local medication is ineffective, freezing or carbon dioxide laser gasification can be used for treatment. If it is still ineffective, partial resection of the middle and lower turbinates can be considered.
To prevent chronic rhinitis, it is necessary to exercise and enhance the body's defense ability. At the same time, we should pay attention to diet and environmental hygiene, quit smoking and drinking, treat systemic diseases, correct nasal deformities, and remove lesions near the nasal cavity. Some drugs, such as reserpine and contraceptives containing estrogen, can cause congestion of nasal mucosa, so other drugs should be used instead.
During treatment, nasal vasoconstrictors should not be abused. Generally, drop it 2 ~ 3 times a day. The principle is to use it as little as possible, especially for children. If used in large quantities for a long time, it will cause drug-induced rhinitis. Once it happens, the drug should be stopped immediately, and normal saline or 25% hydrocortisone acetate nasal drops should be used instead, and the condition is expected to gradually ease.
What is the concept and etiology of chronic rhinitis?
Chronic rhinitis refers to the inflammation of nasal submucosa that lasts for more than several months, or repeated inflammation, and it has not returned to normal during the intermittent period, and there is no obvious pathogenic microbial infection. Clinically, chronic rhinitis can be divided into two types: chronic simple rhinitis and chronic hypertrophic rhinitis, but they cannot be completely separated in histology, and there are many transitional types. Chronic hypertrophic rhinitis mostly develops from chronic simple rhinitis.
The exact cause of chronic rhinitis is unknown, but it is related to the following factors:
1, local factors
(1) Recurrence of acute rhinitis or incomplete treatment;
(2) Long-term effects of chronic nasal cavity and sinus diseases: for example, the nasal mucosa of patients with chronic suppurative sinusitis is stimulated by pus for a long time; Severe deviation of nasal septum hinders nasal ventilation and drainage, making nasal mucosa prone to repeated infection and difficult to fully recover;
(3) The influence of adjacent lesions: mainly inflammatory lesions, such as chronic tonsillitis and adenoid hypertrophy;
(4) Improper nasal medication or prolonged medication: If long-term use of Dibijing or ephedrine will cause vasodilation and mucosal swelling, causing drug-induced rhinitis; Lidocaine and tetracaine can damage the mucociliary transport function of nasal mucosa.
2. System factors
(1) Chronic systemic diseases, such as anemia, diabetes, rheumatism, tuberculosis, heart, liver, nephropathy, autonomic nervous dysfunction, chronic constipation, etc., can cause long-term congestion or reflex congestion of nasal mucosa blood vessels;
(2) malnutrition: such as lack of vitamin A and vitamin C;
(3) endocrine disorders: such as hypothyroidism can cause nasal mucosal edema; During pregnancy and lactation, nasal mucosa often appears physiological congestion and swelling;
(4) such as tobacco and alcohol hobbies
3. Occupational and environmental factors: long-term or repeated inhalation of dust (such as cement, coal dust and flour). ) or harmful chemical gases (such as SO2 and formaldehyde). ), as well as the sharp changes in temperature and humidity in living or production environment (such as steelmaking, baking and freezing operations), can all lead to this disease.
4. The occurrence of the disease is also related to individual immune dysfunction and allergic reaction.
What are the main symptoms and signs of chronic simple rhinitis?
The symptoms of chronic simple rhinitis are nasal congestion and increased nasal discharge, as well as olfactory disorder and headache. Nasal congestion is intermittent and sometimes persistent, and its lower side is heavier when lying on your side. Nasal congestion is often relieved after exercise or in fresh air, but it is aggravated when reading, calculating or manual operation. Severe nasal congestion can lead to nasal obstruction, decreased sense of smell and headache, sometimes causing inattention and insomnia. Secretions increase, generally viscous and translucent, with occasional pus. Long-term irritation of nasal mucus to nasal vestibule and upper lip skin can cause nasal vestibulitis, eczema or folliculitis, especially in children. Nasopharyngitis and otitis media can be caused by nasal mucus flowing back into the throat, and patients may mistakenly inhale phlegm and have hearing loss.
The examination showed that the bilateral inferior turbinates were swollen, and the surface was smooth and moist, showing dark red. The elderly, the weak, the anemia and the hypothyroidism only see swelling but no congestion. The mucosa of the inferior turbinate is soft and elastic, and it will sag when touched by a probe, and it can recover immediately after the probe is taken out. The nasal cavity is not easy to see the whole picture because of mucosal swelling, and only viscous secretions can be seen between the inferior turbinate, nasal septum and nasal floor. The nasal mucosa responds well to vasoconstrictors.
Chronic simple rhinitis is bilateral, without ulcer, granulation, necrosis, odor, paroxysmal sneezing and watery secretion, which can be distinguished from other rhinitis. The prognosis is generally good, which can be cured after proper treatment and the nasal mucosa can return to normal. However, if the pathogenic factors are not removed or treated improperly, the disease can also evolve into hypertrophic rhinitis.
How should chronic simple rhinitis be treated?
The treatment principle of chronic simple rhinitis is to eradicate the cause and restore the nasal ventilation function. The following treatment measures can be taken.
(1) Treatment according to the cause: Carefully identify all or part of the cause and give timely treatment. At the same time, we should pay attention to protecting the environment, improving working conditions, strengthening physical exercise, strengthening physical fitness and improving physical resistance.
(2) local treatment:
① If nasal secretions are sticky, 9% normal saline can be used to wash the nasal cavity to avoid infection caused by long-term accumulation of secretions.
② nasal drops with vasoconstrictor: 0.5% ~ 1% ephedrine saline or nasal drops can be used, but it can cause drug-induced rhinitis and aggravate nasal congestion, which should be considered.
③ Blocking therapy: 0.25% ~ 0.5% procaine can be used to block the nasal passages, or injected into the nasal wall or the front end of inferior turbinate by submucosal injection, 65,438+0 ~ 65,438+0.5 ml each time, 65,438+0 times every other day, 5 times as a course of treatment.
(3) TCM syndrome differentiation and treatment: TCM calls this disease "nasal smothering", which is thought to be caused by accumulation of heat in lung meridian and deficiency of both lung and spleen. Its syndrome and treatment are as follows: ① lung meridian heat syndrome: nasal congestion is light or heavy, or alternately blocked, yellow and sticky nose, small amount, nasal heat, turbinate swelling, good contraction response, yellow and sticky nose; Red tongue and yellow pulse. It is advisable to clear lung heat, promote blood circulation and dredge orifices. The prescription of Qin Huang decoction and Xanthium sibiricum powder is: Scutellariae Radix 30g, Atractylodis Rhizoma 10g, Cortex Mori 15g, Fructus Gardeniae 15g, Fructus Forsythiae 12g, fried lobster sauce 10g, Radix Paeoniae Rubra 15g and Radix Platycodi. Decoct with water. ② Deficiency of lung and spleen: when the nose is blocked, it is light or heavy, or it occurs alternately, and the runny nose is white and sticky, or thin, which is aggravated by cold. Examination shows that the nasal mucosa is pale white or red and swollen, with turbinate hypertrophy and decreased sense of smell, which may be accompanied by dizziness, bad wind and easy to catch a cold; The tongue is pale, the coating is white, and the pulse is thin. Treatment should benefit lung and spleen, dispel cold and dredge orifices. The addition and subtraction of Buzhong Yiqi Decoction and Xanthium sibiricum Powder are as follows: Astragalus root 30g, Codonopsis pilosula 15g, Atractylodes macrocephala 12g, Angelica sinensis 12g, Bupleurum root 10g, Cimicifuga rhizome 10g, Pericarpium Citri Tangerinae 12g, Poria 20g. Decoct with water. Biyanling nasal drops for external use (see question 108), 2 drops each time, 3 times a day. You can also use 50g of centipede, 6g of camphor and * * * to grind fine noodles, and bottle and seal. When you use it, you can plug your nose with cotton wool and change the medicine every day/kloc-0 times.
(4) Acupuncture: Xiang Ying, Hegu and Shangxing points are selected; For headache, use Fengchi point, Taiyang point and acupoint for moderate stimulation, and keep the needle at point 15 once a day or every other day.
What are the clinical manifestations and treatment methods of chronic hypertrophic rhinitis?
Chronic hypertrophic rhinitis is a chronic inflammation of nasal cavity, which is characterized by localized or diffuse hypertrophy of mucosa, submucosa and even bone. Its nasal mucosa is hyperemia and edema for a long time, followed by fibrous tissue hyperplasia, mucosal hypertrophy, and sometimes periosteum hyperplasia and turbinate hyperostosis can be seen. Generally, the inferior turbinate is the heaviest, and nodular or mulberry hypertrophy or polypoid changes may occur in the anterior, posterior and inferior edges of the inferior turbinate and the anterior end of the middle turbinate.
The clinical manifestations of chronic hypertrophic rhinitis are: heavy nasal congestion, mostly persistent, nasal obstruction and decreased sense of smell. There is not much nasal mucus, which is mucus purulent. If the posterior end of the hypertrophic inferior turbinate compresses the pharyngeal orifice of the eustachian tube, tinnitus may occur and hearing loss may occur. Chronic pharyngitis, headache, dizziness, insomnia, dreaminess and listlessness are easy to occur due to long-term stimulation of mouth breathing and secretions. It was found that the mucosa and turbinate bone were thick, and the surface of nasal mucosa was uneven, nodular or mulberry-shaped, pale, reddish or purplish red. Palpation has a hard feeling and there is no depression when pressing. Or depressed, but it is not easy to recover immediately. Using ephedrine, the mucosa does not contract or contracts very little.
For the treatment of chronic hypertrophic rhinitis, in addition to the etiology treatment, the following methods are also used to shrink the turbinate and relieve symptoms such as nasal congestion.
(1) Injection of submucosal sclerosing agent into inferior turbinate.
Suitable for early hypertrophic rhinitis, commonly used drugs are 80% glycerol or 20% sulfathiazole sodium, or 50% glucose solution, or 5% sodium morrhuate. After topical anesthesia, the injection needle was inserted backward into the submucosa from the front end of the inferior turbinate until it was close to the rear end of the inferior turbinate, and then the needle was slowly withdrawn, and the sclerosing agent was injected while withdrawing the needle. The injection volume is about 65438 0 ml. According to the contraction of inferior turbinate, it can be injected repeatedly after 2 ~ 10 days, usually 3 times as a course of treatment.
Attention should be paid to the injection of sclerosing agent: ① The thickness of injection needle is appropriate, which is easy to bleed if it is too thick, and it is difficult to inject oil drugs if it is too detailed. If there is blood during injection, the injection site should be replaced. (2) It is not easy to inject too much at a time, which will make the mucosa white, so as not to cause mucosal necrosis. (3) If there is any systemic reaction during injection, stop the injection immediately and let the patient lie flat with his head slightly lower. ④ In order to prevent blindness or visual impairment caused by retinal artery spasm, a rapid vasodilator such as isoamyl nitrite should be prepared.
(2) Submucous electrocoagulation of inferior turbinate: high-frequency current is used to coagulate hypertrophic tissue, causing scar contraction. After topical anesthesia, a fine needle was inserted into the mucosa at the front end of the inferior turbinate several times from front to back, without touching the bone, and then solidified while pulling out the needle.
(3) Cryotherapy: place the head of hyperbaric oxygen freezer (-50℃ ~-60℃) at the lower turbinate hypertrophy for about 2 minutes; If a liquid nitrogen freezer is used, the temperature can be lowered even lower and the time will be shortened accordingly. Pay attention to complications such as pain, swelling and adhesion when freezing.
(4) Simple submucosal resection of inferior turbinate: The patient takes a sitting position or a semi-recumbent position, carries out nasal surface anesthesia with 1% dicaine, injects 1% lidocaine containing a small amount of 1‰ adrenaline into the submucosa of inferior turbinate, and resects the diseased mucosa of inferior turbinate with turbinate scissors within a predetermined range. Take out the excised hyperplastic tissue, stop bleeding with epinephrine cotton tablets, and then fill the nasal cavity with vaseline gauze.
(5) Excision of hypertrophic mucosa together with bone: The method is basically the same as that of simple mucosal lesion resection, except that part of turbinate bone is removed.
In principle, the resection range should not exceed 1/3 of the inferior turbinate. If the excision is too much, secondary atrophic rhinitis may occur. Contraindications for partial inferior turbinectomy: ① acute upper respiratory tract inflammation; ② It is called hemorrhagic disease or hemorrhagic nature; Menstruation in March; ④ Patients with serious systemic diseases such as hypertension, heart disease, liver cirrhosis and chronic nephritis.
Traditional Chinese medicine believes that this disease belongs to the category of "nasal smothering". Its pathogenesis is mostly related to the persistence of evil toxin, qi stagnation and blood stasis. Symptoms include swelling and hypertrophy of the turbinate, hard and dark color, or mulberry-like, or nodular, persistent aggravation of nasal congestion, yellow and thick or white nose, decreased sense of smell, poor language, cough with excessive phlegm and tinnitus. Red tongue with ecchymosis and thin pulse. The treatment should harmonize qi and blood, remove blood stasis and dissipate stagnation. The prescription of Xuefu Zhuyu Decoction is: Angelica sinensis 12g, Radix Paeoniae Rubra 15g, Radix Rehmanniae 15g, Rhizoma Chuanxiong 15g, Semen Persicae 10g, Flos Carthami 10g and Radix Bupleuri 10g. Decoct with water. Biyanling nasal drops for external use are used for long-term nasal drops. Compound Danshen injection or Angelica injection can also be injected under the submucosa of inferior turbinate. After routine topical anesthesia, take 2ml of Angelica injection and inject it into the inferior turbinate, 1 time, every 2 days 1 time, and 3 times for 1 course of treatment.
Why can chronic hypertrophic rhinitis lead to hearing loss?
Anatomically, the nose and ears are connected by the eustachian tube. The pharyngeal orifice of eustachian tube is located on the lateral wall of nasopharynx, about 1 ~ 1.5 cm from the posterior end of inferior turbinate. Therefore, the swelling or hypertrophy of the inferior turbinate often causes nasal congestion, which in turn affects the ventilation and drainage of the eustachian tube and causes ear symptoms such as tinnitus and hearing loss.
Under normal circumstances, the eustachian tube can adjust the middle ear pressure by opening and closing the cavity of its cartilage segment, so as to keep it basically in balance with the external atmospheric pressure. At the same time, through the ciliary movement of eustachian tube mucosa, secretions can be discharged from the middle ear to the nasopharynx, thus playing a drainage role for the middle ear.
When turbinate hypertrophy is caused by chronic hypertrophic rhinitis, the pharyngeal orifice of the eustachian tube is blocked, and the outside air cannot enter the middle ear. The original gas in the middle ear is gradually absorbed by the mucosa, resulting in negative pressure in the cavity, swelling of the mucosa of the middle ear, increased capillary permeability, a series of pathological changes in the mucosa of the middle ear, increased goblet cells and secretions, forming tympanic effusion, hindering the transmission of sound waves, thus causing hearing loss.
So chronic hypertrophic rhinitis can lead to hearing loss.
chronic rhinitis
Chronic rhinitis is chronic inflammation of nasal mucosa and submucosa. Chronic simple rhinitis is characterized by chronic congestion and swelling of nasal mucosa. If it develops into hypertrophy of nasal mucosa and turbinate, it is called chronic hypertrophic rhinitis. The main causes include recurrent acute rhinitis or incomplete treatment, long-term stimulation or deformity of adjacent chronic inflammation such as sinusitis and tonsillitis, and drug-induced rhinitis caused by improper nasal medication (usually after long-term use of Didijing). In addition, long-term chronic diseases, vitamin A or C deficiency, excessive tobacco and alcohol use, long-term use of antihypertensive drugs such as reserpine, environmental pollution and other systemic reasons can all cause this disease. The main symptoms are nasal congestion and runny nose. Hypertrophic rhinitis can be characterized by persistent nasal congestion, while simple rhinitis is intermittent nasal congestion.
Visit guide:
1, we should pay attention to the self-treatment and health care of the causes of our own diseases.
2. To solve the problem of nasal congestion, 1% ephedrine or furacilin ephedrine solution and chloramphenicol ephedrine solution can be dripped into the nose three times a day.
3.0.25~0.5% procaine can be used for nasal colliculus sealing or submucosal sealing of inferior turbinate, each time 1~ 1.5ml, every other day 1 time, or twice a week, with 5 times as a course of treatment.
4. When the nasal congestion is heavy, sclerosing agent can be injected into the inferior turbinate for treatment, or laser microwave coagulation can be used for treatment. Among them, microwave and laser therapy are commonly used in clinic.
5, surgical treatment, mainly for hypertrophic rhinitis, you can do partial resection of the inferior turbinate.
6, nose drop method: the patient is lying in bed. Rest your head on the edge of the bed and hang it at a 90-degree angle with your body. Drop it into the nose, 2-3 drops on each side, and so on. Get up in about 3 minutes, which will prevent the medicine from entering your throat. This method is not suitable for the elderly.
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