Release date: 2014-03-05
Recently, many cases of medical treatment and medical murder have occurred in the otolaryngology department, making the original terminology of "airborne nose" a public concern. Experts said -
Surgery caused by empty nose is rare, doctors will fully consider the possible complications before surgery. Functionally, the healthy nasal cavity is an air conditioner that can sense the smell, warm and humidify the inhaled air, and filter the dust in the air. However, because of various reasons, the lack of tissue and the excessively smooth nasal cavity will cause the patient to suffer from the so-called "empty nose".
Empty nose, also known as empty nose syndrome (ENS), medical explanation is a rare iatrogenic chronic debilitating disease caused by excessive nasal resection of the nasal cavity with abnormal nasal obstruction and other symptoms. Nasal congestion and nasal or nasopharynx, pharyngeal dryness, some patients have suffocation, attention can not concentrate, fatigue, irritability, anxiety, depression, nasal secretions, bloody secretions, malodor, olfactory decline and other symptoms.
It is understood that in the domestic otolaryngology community, "air nose" is not currently considered a disease, and its name is controversial. Doctors usually do not write a definitive diagnosis on the medical record, but mostly a vague description.
<br> nasal surgery is not the main cause of examination can be found in the patient's nasal cavity in a spacious "tubular shape." In the past, airborne nose syndrome was misdiagnosed as atrophic rhinitis, and now doctors have a new understanding of the clinical manifestations, diagnosis and treatment of this disease.
To be precise, airborne nose is a symptom of excessive nasal patency. Some people suffer from atrophic rhinitis due to autoimmune problems, and they may not have surgery.
"At present, medical science still does not know the pathophysiological basis of air-nose syndrome. Simply saying that too much nasal resection can not explain all the problems. For example, some tumor patients have empty nasal cavity. Although nasal ventilation is uncomfortable, there is very little similarity. The situation happened." In an interview, Zhou Bing, director of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, said.
"Inappropriate surgery, excessive removal of part of the inferior turbinate, will increase the width of the nasal cavity, which is indeed possible. But in general, although the nose will have dry discomfort, it will cause atrophy of the nasal mucosa, resulting in atrophy Rhinitis is extremely rare. If the nasal discomfort is attributed to atrophic rhinitis, or even 'empty nose', it will expand the face a bit," said an otolaryngologist.
Liang Yong, a professor of otolaryngology at the Southern Hospital of Southern Medical University, said: "In clinical practice, for a more experienced doctor, the airborne nose caused by surgery is rare, because the doctor may cause it before surgery. Complications will be fully considered."
According to Liang Yong's analysis, "airborne nose" may be caused by three kinds of conditions: one is the abnormality of the anatomical structure of the congenital or acquired nasal cavity; the other is the nasal mucosa caused by acquired diseases such as atrophic rhinitis and special nasal inflammation. Bone destruction; the third is caused by surgery, which includes surgery that has to be performed, such as nasal tumor resection, and there are too many nasal structures removed due to insufficient doctor experience or insufficient grasp of the disease, that is, surgery concurrently The situation of the disease.
In recent years, the academic community has begun to emphasize the protection of the structure of the turbinate and nasal septum. If there is no indication for surgery, the doctor cannot remove it casually. However, Liang Yong also pointed out that the degree of partial resection of the turbinate is sometimes difficult to grasp, and the individual circumstances of "airborne nose" caused by surgery are inevitable.
The role of psychological factors is large. "Airborne nose is closely related to psychological and mental factors. The same two patients have the same nasal patency, but the expression of nasal comfort is different. This situation is often encountered in clinical practice." Shandong Yang Zhengang, an otolaryngologist at Tai'an Central Hospital, said, "The patient who looks very smooth in a nose examination is complaining of nasal congestion, or the shape of each turbinate is normal, but the patient complains that the nose is dry and feels too smooth. This situation is extremely common."
That is to say, even if a patient feels a dry nose and is too smooth after surgery, the nasal examination is completely normal, but because of mental and psychological anxiety, depression, etc., it may also cause his subjective feeling and objective examination to separate.
However, the severity of the symptoms of airborne nose is more determined by the patient's subjective feelings and cannot be judged directly from the anatomy. Since the nasal cavity is located on the head, slight carelessness can affect the function of the brain's nerves, and changes in these functions can have a great impact on human emotions.
"Therefore, in the endoscopic surgery, the treatment of the inferior turbinate mucosa should be cautious, try not to remove the inferior turbinate mucosa." Yang Zhengang said.
Patients don't easily "check in"
"Patients should not diagnose on their own, think that there is a feeling of discomfort such as nasal discomfort, dizziness, head swelling, etc. is 'empty nose disease', and even push the responsibility to the surgeon without reservation." Yang Zhengang said.
It should be understood that endoscopic surgery is not just a kind. If you have sinusitis or nasal polyps, you will never remove the normal inferior turbinate during surgery, only remove the polyps, open the relevant sinus, and treat the lesions. Turbinate; as long as the inferior turbinate is completely preserved, there will be no "empty nose".
According to Yang Zhengang, if it is a nasal septum surgery + inferior turbinate surgery, only a plasma ablation, or partial resection of the inferior turbinate bone, there will be no so-called "empty nose". Even if part of the inferior turbinate mucosa is removed, as long as most of the inferior turbinate is retained, the occurrence of "airborne nose" is minimal. Therefore, for "empty nose", patients with endoscopic surgery should not be "checked in".
More conservative treatment <br> It is understood that the treatment of medical airborne nasal disease has been relatively mature. Excessive dryness of the nasal cavity can be partially moisturized with peppermint oil and physiological saline. When the nasal mucosa is scarred, it can be washed by medicine. If the internal structure of the nasal cavity is abnormally wide and the ventilation is excessive, the mature nasal cavity narrowing surgery can effectively alleviate the symptoms. Moreover, patients should have a good attitude towards the disease, do not let the nose discomfort affect the mood, and thus become a psychological problem.
Liang Yong said that the nose-related treatments are performed when the patient has symptoms. Some patients have obvious sputum, and the nasal septum is very severe, but he is not uncomfortable, so don't treat it casually. Treatment of rhinitis and other diseases should be treated conservatively.
To relieve the symptoms of airborne nose, doctors have two suggestions: First, you can use cotton balls to block one side of the nostrils, alternating, can reduce or eliminate symptoms; second, divert attention, do not always think about the nose is uncomfortable, if necessary You can see a psychiatrist.
"In the course of treatment, communication between doctors and patients is very important." Zhou Bing believes that the medical examination results may be normal, but the patient is very painful and anxious. Helping patients to relieve mood is an important part of treatment. "For some patients, surgery can be used. On the one hand, it is to reduce the nasal cavity or nasal vestibule, to relieve hyperventilation, on the other hand, it also has a certain psychological suggestion."
Liang Yong suggested that doctors must decide whether or not surgery and the scope of surgery according to the specific circumstances of the patient. Sometimes it is better to be conservative. Be sure to tell the patient about possible postoperative symptoms and risks before surgery.
Extended reading:
Empty nose is an unsolved mystery
Recently, airborne nose has received much attention. What is this disease? How to diagnose treatment? According to reports, in terms of function, the nasal cavity is an air conditioner that can sense the smell, warm and humidify the inhaled air, and at the same time play a filtering role.
In addition, the mucosa of the nasal cavity, especially the mucosa of the turbinate, can feel the entry of gas into the nasal cavity. If the mucous membrane is missing more, the effect of "air conditioning" is weakened, and a cool breeze will directly enter the lungs when breathing, resulting in a very uncomfortable feeling.
What is empty nose? Zhou Bing, director of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, said that this is a clinical syndrome associated with excessive nasal tissue loss, and the corresponding imaging findings of nasal sinus, clinically known as empty nose syndrome. Most people believe that the disease is associated with excessive removal of the turbinate.
What is the turbinate? "There are some rugged structures in the nasal cavity, which are called turbinates in an anatomical shape. The surface is covered with a layer of mucous membrane, and the surface of the mucous membrane is covered with mucus." Zhou Bing said.
"Among the 21 patients diagnosed with empty nose syndrome, some of them were related to the removal of the turbinate (mainly the inferior turbinate). Some patients had no excessive removal of the inferior turbinate. Some patients had even a normal shape of the turbinate. Zhou Bing said, "There are two cases of nasal septum surgery and no treatment of the turbinate. These patients were evaluated by the psychology department before surgery, and almost all had different levels of anxiety and depression."
"At present, medical science still does not know the pathophysiological basis of air-nose syndrome. Simply saying that too much nasal resection can not explain all the problems. For example, some tumor patients have empty nasal cavity. Although nasal ventilation is uncomfortable, there is very little similarity. The situation happened." Zhou Bing said.
It is understood that the turbinate surgery has existed for nearly two centuries, and there is no exact number of cases of airborne nose syndrome.
"Air nose syndrome is an unsolved mystery, it should be caused by a combination of factors." Zhou Bing said. In the basis of diagnosis, the occurrence of mental and psychological disorders is a necessary condition.
During the treatment process, communication between doctors and patients is very important. Maybe the medical examination results are normal, but the patient's feelings are not comfortable, this feeling will make the patient very anxious and painful. Therefore, helping patients to relieve mood is an important part of treatment.
For some patients with empty nose syndrome, surgery can be used. On the one hand, it is to narrow the nasal cavity or nasal vestibule, relieve hyperventilation, and on the other hand, it has a certain psychological suggestion.
Source: People's Network
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