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Tuberculosis of the nose

Mycobacterium tuberculosis, spreading along the lymphatic and circulatory pathways, enter the nose from the focus, which may be in the lungs, joints or larynx. In rare cases, the infection enters the nasal mucosa by contact.

The pathomorphological substrate of the disease is infiltration - an accumulation of specific tubercles in the submucosal layer.

Tuberculous tubercle is an accumulation of small round, giant and epithelioid cells among the thin connective fibers. The curdled decay of these tubercles leads to the formation of ulcers. Tuberculous ulcer - a superficially located mucosal defect, the bottom of which is covered with granulations. The most characteristic localization of tuberculous tubercles or ulcers is the cartilaginous part of the nasal septum, the anterior end of the lower and middle nasal concha.

K l and n and with to and to kartin and. Tuberculosis of the nose in the initial stage is characterized by profuse discharge from the nose, crusting and a feeling of stuffy nose. With the breakdown of infiltrates and the formation of ulcers, purulent discharge with an admixture of blood appears. In one or another half of the nose, an accumulation of crusts is detected, upon removal of which one can see infiltrates in the mucous membrane. With rhinoscopy, ulcers are defined as a mucosal defect, at the bottom of which sluggish granulations are located.

D and a g n about with t and to and. If the patient has a tuberculous process in the lungs, larynx, joints and other organs, the diagnosis is not difficult. Differential diagnosis should be carried out for syphilitic lesions of the nose (tertiary syphilis).
Syphilis is characterized by damage not only to the cartilaginous, but also to the bone part of the nasal septum. In addition, with syphilis, a lesion of the nasal bones (saddle nose) is observed, which can cause a pronounced pain syndrome in the region of the nasal bridge. Some help in the differential diagnosis is provided by the Wassermann serological reaction and the Pirke reaction (especially in children). An infiltrative or ulcerative lesion of the nasal mucosa often has to be distinguished from a tumor. In these cases, the diagnosis should be based on the results of a biopsy and microscopic examination of a piece of tissue.

Treatment General and local treatment is carried out, taking into account the general prevalence of the process. As a general treatment, isoniazid, rifampicin in combination with PASK, phtivazide, streptomycin, etc. are used. The basis of local treatment is cauterization of infiltrates and ulcers with various acids (trichloroacetic, 80% lactic, etc.), apply 10-20% ointment from pyrogallic acid, potassium iodide is prescribed inside for 4-8 weeks. In some cases, the affected part of the nasal septum or shells is excised, followed by galvanic caustic of the edges of the defect. A positive effect is obtained by irradiating the nasal mucosa with quartz through a tube.

The prognosis is favorable, however, it depends mainly on the prevalence of pathomorphological changes in the main focus. Perforation of the anterior nasal septum is possible.
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Tuberculosis of the nose

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