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Diseases of the external nose and nasal cavity

Congenital anomalies of the external nose in the form of its complete absence, splitting of the tip of the nose, double nose, etc. are extremely rare and do not have such practical significance as congenital and acquired changes in the nasal cavity, leading to impaired patency of the nasal cavity for inhaled and exhaled air.

Narrowing and overgrowing of the nasal cavity. Sometimes there is a congenital narrowness of the nasal passages in one or both halves of the nasal cavity. In other cases, the congenital narrowing concerns only the entrance to the nose and consists in partial or complete overgrowth, or atresia, of the nostrils (from the Greek. Tresis - hole, and - denial, absence). As a relatively rare anomaly, inspiratory (inhalation) suction of the wings of the nose occurs due to the weakness of the muscles that expand the nostrils. In such cases, the nostrils do not expand when inhaled, but, on the contrary, the wings of the nose are attached to the nasal septum, which complicates the passage of air into the nasal cavity.

Atresia is sometimes observed in the choan region, i.e. openings connecting the nasal cavity with the pharyngeal cavity. Atrizia can be complete or incomplete, unilateral and bilateral.

In most cases, fusion in the nose is the result of scarring in ulcerative processes that develop in the nose due to some acute and chronic infectious diseases (for example, smallpox, diphtheria, lupus, syphilis).

The elimination of fusion is achieved only through surgical intervention, which sometimes turns out to be very difficult, especially with atresia of the choanas.

Damage to the nose. Bruises of the nose are quite common, especially in childhood. Often they are accompanied by damage to the bone skeleton of the nose - both external (nasal bones) and internal (nasal septum).

As a result of damage to the nasal bones, deformation of the nose may occur in the form of its displacement to the side or retraction of the back. In case of damage to the nasal septum, submucosal hemorrhage or hematoma very often forms, which in most cases turns into an abscess (from lat. Absessus - abscess). An abscess of the nasal septum often, and in young children almost always, leads to a retraction of the nasal dorsum due to resorption of the cartilage of the nasal septum.

The retraction of the nasal bridge leads, as a rule, to a significant deformation (saddle nose), and often to a violation of the resonant function of the nose (nasal).

To prevent the development of an abscess and subsequent deformation of the nose with injuries of the nasal septum, early treatment is necessary. Therefore, at the slightest suspicion of the formation of a hematoma of the nasal septum (a symptom is unilateral nasal congestion), the child should be urgently shown to the otolaryngologist.

Treatment for deformities of the external nose is to restore its shape through plastic surgery. These operations are usually performed only at the end of the growth period of the facial skeleton, i.e. after 14-16 years.

Curvature of the nasal septum. The nasal septum only in relatively rare cases is completely straight, more often it is curved in one direction or another (Fig. 74). In addition, often on the septum there are thickenings in the form of spikes and ridges. In some cases, the curvature reaches such a degree that it greatly complicates nasal breathing.

Fig. 74.

Septal curvature

The reason for the curvature of the nasal septum and the development of spikes and ridges on it is the uneven growth of various parts of the nasal skeleton: the nasal septum grows faster than the surrounding bone frame (the roof and the bottom of the nose) expands. Often the cause of septum curvature is also nose bruises in early childhood (falling on the nose).

Straightening of the nasal septum is performed by surgery. The operation consists in removing the curved parts of the septum, and only the osteo-cartilaginous plate is removed, and the mucous membrane is preserved. Surgery on the nasal septum, as well as external plastic surgery of the nose, is performed after 14-16 years.

Foreign bodies of the nose. Foreign bodies in the nose are most often observed in children who, during a game or out of prank, stick various small objects into their nose: pebbles, beads, buttons, cherry pits, peas, sunflower seeds, etc.

Foreign bodies lead to blockage more often than one, and sometimes both halves of the nasal cavity and often cause purulent inflammation of the nasal mucosa. The appearance in the child of nasal discharge with a purulent smell is a characteristic sign of the presence of a foreign body, especially if pus is secreted from only one half of the nose.

In most cases, foreign bodies get stuck in the initial section of the lower nasal passage and are easily removed by the experienced hand of a doctor under the control of vision. It must be firmly remembered that there is no need to rush to remove foreign years from the nose, since there is no particular harm from their stay in the nose even for several days. Therefore, you should never try to remove objects stuck in your nose yourself, despite all the apparent availability and seductive ease of removal. All inept attempts to remove foreign bodies from the nose of any kind with tweezers and forceps, as a rule, end up pushing the foreign body into the deeper parts of the nose, which complicates the subsequent removal.

Coryza. Acute inflammation of the nasal mucosa, or acute runny nose, is one of the most common diseases. Acute runny nose can be observed as an independent disease or as one of the manifestations of a common infectious disease (influenza, measles, scarlet fever, diphtheria, etc.).

The cause of acute rhinitis in most cases is the penetration of pathogenic microorganisms into the thickness of the mucous membrane. Most often, a runny nose occurs as a result of a cold, i.e. cooling the body or legs, staying in a draft, in damp, etc. However, the common cold serves only as a predisposing cause, causing a weakening of the whole organism and a decrease in the resistance of the nasal mucosa to the infectious agent.

Signs of an acute cold at the onset of the disease are a feeling of dryness and burning in the nose and nasopharynx, sneezing, a slight increase in temperature. When examining the nasal cavity at this time, there is redness and swelling of the mucous membrane, swelling of the nasal concha. After a few hours (sometimes after 2-3 days), dryness in the nose is replaced by copious liquid secretions, which gradually thicken, become mucous, and then acquire a purulent character. Swelling of the mucous membrane causes nasal congestion: the patient cannot breathe through the nose, feels heaviness in the head, general weakness and weakness. Very often, the inflammatory process goes to the mucous membrane of the sinuses, and then severe headaches can occur.

Stuffing the nose leads to a change in the timbre of the voice, nasal appears. During an acute cold, the sense of smell is often disturbed.

The inflammatory process can spread through the Eustachian tube into the middle ear and cause the disease of the latter (see “Qatar of the middle ear”, “Acute inflammation of the middle ear”).

Of acute importance is an acute runny nose in infants. Even a slight swelling of the nasal mucosa causes a complete blockage of the nasal cavity in young children, as their nasal passages are very narrow. Obstruction of the nose in infants causes not only disorders associated with a lack of nasal breathing (poor sleep, dry mouth and pharynx), but also often leads to exhaustion, since a child who is forced to breathe through his mouth all the time cannot suck normally.

Treatment of acute rhinitis is reduced to eliminating nasal congestion through various medications, as well as to the treatment of the underlying disease that caused the rhinitis.

Prevention is aimed at hardening the body. Children should walk outdoors in any weather. Clothing should not be too light or too warm (do not wrap children). Very useful gymnastic exercises in the air, as well as classes in summer and winter sports.

Chronic runny nose. Acute runny nose with frequent repetition can turn into chronic. Chronic inflammatory processes in the nasal mucosa can occur without a previous acute illness in cases of prolonged and repeated exposure to harmful moments. Such harmful moments include frequent and prolonged inhalation of cold and hot air, an admixture of various irritating particles in the form of dust, smoke, gases to the inhaled air.

Chronic runny nose can also occur as a result of an inflammatory process in neighboring parts of the respiratory tract, for example, in the nasopharynx with adenoid growths in the paranasal sinuses.

There are four forms of chronic runny nose: 1) a simple chronic runny nose; 2) hypertrophic runny nose; 3) atrophic runny nose; 4) allergic rhinitis.

A simple chronic runny nose is characterized by periodic nasal congestion and more or less profuse mucous secretions. When lying, swelling in the nose increases. Patients usually declare that when lying on their backs, both halves of the nose are blocked, and when lying on their side, the half that is below is blocked.

In chronic runny nose, overgrowth, or hypertrophy (from Greek hyper - over and trophe - nutrition, increase) of the nasal mucosa often occurs. The mucous membrane sharply thickens, and this thickening does not occur throughout the entire length of the membrane, but in separate areas.

Most often, the posterior and anterior ends of the lower shells, as well as their lower edge, are thickened (Fig.
75). These thickenings often have a rough surface and look like a mulberry or raspberry upon examination. This form of the disease is called hypertrophic rhinitis. Nasal congestion in hypertrophic rhinitis is more constant and does not change depending on the position of the head, as is the case with simple chronic rhinitis. The mucus is thicker and is difficult to separate.

Fig. 75.

Hypertrophy of the lower conch

One of the common complications of chronic runny nose (simple and hypertrophic) is catarrh of the middle ear.

Prolonged swelling or hypertrophy of the posterior ends of the lower nasal concha can cause impaired patency of the Eustachian tubes, which in turn leads to the development of chronic middle ear catarrh.

Atrophic rhinitis is characterized not by thickening, but by thinning of the nasal mucosa, its atrophy (from the Greek atrophia - wilting). This disease usually develops on the basis of a general decline in nutrition or under the influence of constantly acting harmful moments, such as drying the nasal mucosa with hot air, as well as inhaling silicate, cement, tobacco and other types of dust. In some cases, an atrophic runny nose can develop from hypertrophic as its later stage, when wrinkling of overgrown connective tissue occurs.

With a pronounced form of an atrophic rhinitis, the mucous membrane is sharply thinned, covered with dry crusts, and the nasal passages sometimes become so wide that you can see the nasopharynx through them.

Subjective symptoms with atrophic rhinitis are mild. Patients complain of a constant feeling of dryness in the nose and nasopharynx, sometimes a decrease or lack of smell, less often - headaches.

Allergic rhinitis, or rhinitis (from the Greek rhinos - nose), is currently very common. It is caused by various allergens, most often it is pollen of flowering plants, house dust, fungi, honey, chocolate, etc. It can occur in two forms - seasonal (spring-summer) and permanent. The seasonal form is associated with the flowering period of plants and is called pollinosis (from Latin polle - pollen of plants) or hay runny nose. The clinical course is in the form of seizures with nasal congestion, profuse watery discharge from the nose, repeated sneezing. When examining the nasal cavity, the picture is significantly different from the usual infectious rhinitis: the mucous membrane is cyanotic or whitish (edema), there is no purulent discharge, the nasal concha are enlarged. With a constant form of allergic rhinitis, these symptoms persist for a long time, although less pronounced.

Allergic rhinitis is often the cause of other diseases: sinusitis, bronchial asthma, combined with conjunctivitis, urticaria, etc. Treatment of allergic rhinitis begins with the identification and elimination of the allergen. If this elimination is not possible, the so-called specific desensitization (elimination of hypersensitivity) is carried out: for a very long time very small doses of the allergen are introduced, which gradually increase (by the type of vaccination), as a result, patients tolerate seasonal exacerbations more easily. In addition to specific desensitization, antihistamines and corticosteroids are widely used.

Treatment of chronic runny nose should first of all be aimed at eliminating all those reasons that cause it and support it: exposure to cold and hot, as well as moist and excessively dry air, dust, smoke, etc.

With a hypertrophic rhinitis, nasal breathing is restored after the removal of the hypertrophic parts of the mucous membrane by surgery or after their reduction through cauterization, as well as laser exposure.

With an atrophic rhinitis, treatment is directed against the dryness of the mucous membrane and the crusts that form in the nose. It consists in lubricating the mucous membrane, letting in drops or spraying a solution of soda in the nose.

Ozena is a special chronic disease accompanied by a sharp atrophy of the nasal mucosa and the underlying respiratory tract. In contrast to the atrophic rhinitis, not only the nasal mucosa, but also the bony skeleton of the shells atrophy at the lake, so that the nasal passages become even wider with the lake than with the atrophic rhinitis. The formation of dense crusts with an unpleasant odor is especially characteristic of the lake. Due to severe atrophy of the mucous membrane, which also extends to the olfactory region, patients with ozena are usually deprived of smell and do not smell in their nose. Sometimes the smell from the nose at the lake is so harsh and unpleasant that it makes it difficult for patients to communicate with others.

The causes of ozena are still not well understood. Undoubtedly, environmental factors, in particular material and living conditions, play a large role in the development of this disease.

Treatment of the lake is mainly symptomatic and comes down to mechanical removal of the crusts and moisturization of the mucous membrane by washing the nose with alkaline solutions and letting in drops.

Half of the surgical methods proposed by some authors for the treatment of ozena are not widespread in our country because of their low efficiency.

Polyps of the nose. Nasal polyps are rounded tumor formations (Fig. 76), sitting on a thin stalk and emanating most often from the middle nasal passage. Polyps have a grayish, sometimes yellowish-pink color, a smooth surface and a gelatinous consistency. Their magnitude is very diverse: in some patients, many polyps are small, with a pea, in others, the entire nasal cavity is occupied by one huge polyp. Polyps develop mainly in diseases of the sinuses.

Fig. 76. In the right nasal cavity (left picture) - polyps; in the left half (in the figure on the right) -

swelling of the nasal concha

The main complaint of patients is very difficult breathing. Due to obstruction of the nose, speech becomes nasal. Frequent headaches are noted. Hearing is often lowered.

The treatment of polyps is surgical. They are removed under local anesthesia by means of a wire loop through the outer opening of the nose.

Nasal - a pathological change in the timbre of the voice and a distorted pronunciation of the sounds of speech, due to a violation of the normal participation of the nasal cavity in the processes of voice and speech formation. There are two types of nasal nostrils - open and closed. With open nasal during the utterance of all sounds of speech, air passes not only through the mouth, but also through the nose. With closed nasal, air passes only through the mouth.

Complete bilateral atresia of the nose, as well as other pathological processes that cause impaired patency of the nasal cavity, lead to complete or partial shutdown of the nasal resonance. There is a closed nasal. In these cases, the voice loses a number of its overtones, it sounds muffled.

If the obstruction causing the closure of the nasal cavity is in the posterior parts of the nose or in the nasopharynx, then talk about the posterior closed nasal nasal. If there are obstacles in the anterior nasal cavity, anterior closed nasal arises. With anterior closed nasal nasal resonance, sometimes to one degree or another, is preserved.

With closed nasal, the pronunciation of nasal sounds is especially affected. In cases of complete obstruction of the nose, b and d are pronounced instead of the sounds m and n (instead of mother, “woman”, instead of the nanny, “uncle”, etc.). With a partial obstruction of the nose, m sounds like mb - "mbamba", n - like nd - "ndyandya").

In some cases, closed nasal is observed without violating the patency of the nasal cavity for air. Then they talk about functional closed nasal. Такой вид гнусавости возникает иногда у глухонемых в результате отсутствия у них слухового контроля над произношением.

Лечение закрытой гнусавости заключается в оперативном устранении препятствий в носу и носоглотке. После оперативного вмешательства необходимо проводить логопедические упражнения; при функциональной закрытой гнусавости успех достигается одной логопедической работой.

Открытая гнусавость встречается значительно чаще закрытой. При нормальном произнесении всех звуков речи, кроме носовых, мягкое небо обычно примыкает к задней стенке глотки и тем самым разобщает ротовую часть глотки с носоглоткой. Вследствие такого разобщения струя воздуха, образующаяся при звукопроизнесении, направляется через рот. И тогда звуки речи приобретают свой нормальный тембр. Этот тембр не искажается в заметной степени и в тех случаях, когда мягкое небо при своем сокращении несколько отступает от задней стенки глотки, оставляя здесь лишь небольшую (3—5 мм) щель. Голосовая струя воздуха и в этом случае направляется не в нос через узкую щель, а в рот через широкий просвет зева. Речь приобретает гнусавый оттенок, только если значительная часть воздуха попадает в нос. Это происходит обычно при таких дефектах твердого и мягкого неба, как врожденные расщелины, укорочение мягкого неба, параличи и парезы небной занавески и пр.

Открытая гнусавость, так же как и закрытая, нередко бывает функциональной. Такой характер имеет, в частности, открытая гнусавость, остающаяся после устранения механических причин, препятствующих нормальному функционированию мягкого неба, например после удаления увеличенных миндалин. Иногда открытая гнусавость, как и закрытая, наблюдается у глухонемых.

При открытой гнусавости, обусловленной дефектами твердого и мягкого неба, проводится соответствующее лечение.

Логопедические занятия рекомендуется проводить не только в послеоперационном периоде, но и до операции.
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