Cystic polyphysiology of rinosinusity. First look at a sick person when

STORIA HVOROBI

Mainly enlightened: Bilateral polyposis-nyan rhinosinusitis

rhinosinusitis polyposny diagnosis

1. First look at a sick person when needed

Skargi to ENT-Oganov camp:on nasal congestion, the appearance of gnarly visions from the emptying of the nose

Skargi for the mill of the largest organs and systems: At the spring-summer hour, there is an attack of breath, bad breath, cough with mucus mucus.

Anamnesis of this subactivity: Stuck turbine nose for 8 rockets; in 2008, a double-sided polyoetmoidotomy was carried out; through the risk of nasal congestion; There were punctuations from the nose. Lіkuvalasya for help nasal care with a rozchinom Aqualor, Ximelin spray, Ketotifen tablets.

Anamnesis of the given disease is active2008 - bilateral polyoetmoidotomy; MRI from 01/20/2011 - on the nasal sinuses and in the middle of the mastoid protuberances in the mid-nasal cysts of the sinuses correctly; MRI from 10/20/2014 - bilateral chronic pansinusitis (polypoid?

history of life: Dida, tit, niece, onuki - bronchial asthma; tuberculosis, hepatitis, venereal ailments, VIL in myself and close relatives; chronic illness - bronchial asthma; surgery and injuries; Wit me out - I live in a booth, wake up the prats - professional shkidlivy on a colossal mission of robots.

Allergological history:bronchial asthma; allergy to acetylsalicylic acid, Roslin saws, wool of home brews; from the drive bronchial asthma lіkuvalasya in a hospital, іkuvannya drug glucocorticosteroids (prednisolone).

... Spravzhny camp of the sick (Status Praesens)

Zagalny camp average gravity... The position is more active. The evidence is clear. Hoda is great. Viraz revealing the calm. Spookyna behavior. The constitutional type is normosthenic. At the moment, in the hour and in the situation, they get excited. Harchuvannya is normal. Shkіrni obkrivi normal vologosti і vologostі, cicatrices, pigmentation, visip, hematomas and vіdsutni. Porozhnina company without pathology: it is clear to schoplyuyut shyky teeth, white-erysipelas colora, compact, do not bleed when touching; on the move there is an insignificant syro-biliy nalit, vologiy; firm, the palate is gently sloping; Peripheral lymph nodes are not palpable. There are changes from the side of the system and organs of dichotomy: percussion sound with a light box-like appearance, auscultatory - dichotomy is vesicular, side dyshalny noises do not become audible.

3. Dani of ob'ktivnoe obezheniya ENT organs

Ніс і navkolonosovyh sinuses (anterior rhinoscopy):callous nis correct form; palpation at the projection points of the nasal sinuses is painless; the front of the nose is covered with a normal skin with fine hairs; sliza of the black-and-mouth color, swollen; zalny noses go to the sound of the rakhunok to the muck; in both halves of the nose it is smooth, siri, do not bleed, crumbling at the end of the polyp; the septum of the nose is slightly vicious in the offense of the side; viznachatsya blado-zhovte vidіlennya in the middle and lower nasal passages; nasove dikhannya is not difficult; scent weakened.

Oropharynx (mesopharyngoscopy): Slizova sheath of a volog, erysipelas, bliscule; small bows do not change; flashlights behind the arches, smooth, the lacunae are not widened, the vision from the lacunae is visible.

Nasopharynx (epipharyngoscopy):star nasopharyngeal dome small form, Coating with an invisible mucus sheath; the ear of the auditory tubes is large, polypous tissue is seen in the lumen of the right throat.

Laryngopharynx (hypopharyngoscopy):pear-shaped sinus symmetric, side room vidsutnі, the movable migdalene is not changed, the function of kovtannya is not damaged.

Larynx and hypopharynx:with a lasting look at the palpation of the skeleton of the larynx pathological changes dumb; the epiglottis of the ma viglyad of the open-backed pelust of the erysipelas; the voices of the folds, with symmetrical phonation, fade back; the voice is clear, thick, vіdpovіda vіku і statі; dikhannya is not difficult.

into ear: in the shells correct form, nipple-like outgrowth of coatings with an unchanged skin, with painless palpation;

otoscopy:the name of the rumor is wide, on the walls of the yogo in the cartilaginous form of the breast gray color with 5 points (front and back folds, short outgrowth, hammer handle and light reflex).

Right vuho AD Test Left vuho AS-S.Sh.-6 mSh.R. 6 m> 6 mR.R.> 6 M60 S128 / B / 60 30S128 / K / 30 + R + ← W → Passage of the auditory tube I, II, III st.

vestibular passport

Right in the ear AD Test Left in the ear AS Finger-nose test Fills Finger-puncture test Fills Romberg's test Stable Flank gait Fills Spontaneous nistagm Absent Pressure test Negative, 10-th test, 30 test) (5

4. Laboratory dosage

Blood analysis:

Leukocyte 7.8 * 10 9/ l

Lymphocytes 31.9%

Neutrophils 44.6% semi-dry 5 s / mouth 44

Eosinophils 5%

Basofili 1%

Hemoglobin 142 m / l

Erythrocytes 4.35 * 10 12/ l

Platelets 235 * 10 9 / l

In the UAC, an insignificant amount of leukoformula is indicated, which indicates an ignition process, and an eosinophilia indicates an allergic process.

Analysis of the section:

Colir: svitlo-zhovtiy

Reaction: sour

Scoring 1020

Block: enter

Episode: entry

Erythrocytes: enter.

Bacteria: neg.

OAM does not have any standards.

X-ray dosage: MRI dated 10/20/2014 - offending the forehead, upper slit sinuses, mid-gravel labyrinth, filled with soft tissue in place, widening into the empty space of the nose; in the wedge-like sinuses there is an unreasonable level of mucous growth; the nasal septum is rosy; the middle nasal passages are blocked by a pathological space, which widens into the empty nose (more swivel on the right); middle nasal shells do not clearly differentiate; nasopharyngeal tissue and nasopharynx without peculiarities; visnovok - bilateral chronic pansinusitis (polypoid?

5. Determination of clinical diagnosis

Diagnosis established at the office:

)Skarg: on nasal congestion;

)Anamnesis of tsyogo disaster: sickness itself vvazhaє stretching 8 years, in 2008 was carried out surgical treatment (two-sided polypoetmoidotomy).

)Danikh ob'єktivnogo obsozhennya: with anterior rhinoscopy in both halves of the nose, it appears smooth, siri, which does not bleed, crumbling at the end of the polyp; viznachatsya blado-zhovte vidіlennya in the middle and lower nasal passages; nosove dikhannya is not difficult; scent weakened.

)Date of laboratory and instrumental follow-up: according to MRI data from 10/20/2014 - bilateral chronic pansinusitis (polypoid?

6. Differential diagnosis

at chronic emotionalsymptomatology lie in an active process. At the period of a sick man's remission periodically turbo head b_l, More often in the area of the root of the nose, it is transferred, sometimes diffuse. With serous-catarrhal form, the vision is light, ryasne. Gnіyna form is supervised to take on different visions, like a psycho and іtvoryu kirki. Often, seeing from the nose may smell. Zaluchennya to the process of the rear cells of a gratchal labyrinth to produce before the purchase of a vision of the nasopharynx part of a lie, is expectorated with violence. Smell, yak rule, shattered in of the risky step... With rhinoscopy, catarrhal changes appear in the main in the area of the middle of the nose, in the same place there is a localization of the knowledge.

The indigenous camp of the ailments becomes overwhelming, protest against drudgery, outward weakness, increased obesity. During the period of aggravation, symptoms of a severe inflamed ( clear vision from the nose, difficulty in feeling, how to press the beel in the area of the nasal dorsum, temperature).

chronic rhinitis- to reach a large group of illnesses due to the backward symptoms: the main - the vision from the nose, the difficulty of the nasal dichotomy, the reduction of the sense of smell. Ailments may cause turbulence onset symptoms - heaving and burning in the nose, headache, chhannya, morbidity and drowsiness, bruising, dryness in the nose, seeming an unpleasant odor, insignificant nasal bleeding, redness upper lip, Buying up a thick slime in the nasopharyngeal, coldness and loss of sleep .

Gostri sinusiti.Naybilsh is a frequent reason for the development of gostrykh sinusitis є gostri respirators viral infections(ГРВІ), which can be infected by influenza viruses, rhinoviruses, adenoviruses, staphylococci and other ailing microorganisms.

When the sinuses are too hot, as a result of the build up of the mucous membrane of the sinuses, the sinus opening closes up and the infection accumulates in the sinuses, without being in danger of going out of the way, but to create the inflammation of the sinuses before the development of the sinuses.

Gostriy sinusitis is manifested by headache, increased temperature of the body, congestion and nasal visions from the nose, swelling of soft tissues in the area of the affected sinus.

7. Necessity of surgical treatment

It is recommended to conduct a two-way ethmoidopolypotomy. Shown up to the polypotomy є serious damage to the nasal dyhannya, hot-ignited loss of the nasal emptying, as well as the appearance of the effect as a conservative addiction. Prompt treatment of polyps is suggested for: aggravated chronic obstructive bronchitis or bronchial asthma, every hour of the season of allergenic growth during the operative and operative period.

8. Drug treatment

Rp.: Tab. Amoxiklav No. 14

D.S. for one tablet 2 r / d 7 days

With antihistamine methy:

Rp.: Tab. Cetrini 0.01 No. 5

D.S. 1 tablet each 1 r / day 5 days

For usunennya nasal congestion:

Rp .: Aer. Rinofluimucili - 10ml

D.S. one injection into the skin, strictly as needed, not more than three times a day

From the irrigation point, I will stop the emptying of the nose with salt breaks (Aquamaris, Aqualor, Salin).

List of Victory Literature

1. Palchun V.T., Magomedov M.M., Luchikhin L.A. Otorinolaryngology - M., 2011

Ovchinnikov Yu.M. Ailments of the nose, pharynx, larynx and vuha: handbook for medical students - M., Medicine, 2003

Polypoid rhinosinusitis is a pathology, when there is a specific growth of a mucus ball in the nasal passages and sinuses. Rhinosinusitis is called an ignition process in the paranasal sinuses, from the same polypoid type of pathology - the heat, as it is known to have been confirmed.

Polyp is a lot of good growths, which can be of different shapes (often round or oval) and sizes. The goal is to inspect the location in the openings and sinuses. The main reason for the diagnosis of polyp is the compensatory function of the body. And the very thing - when the mucous membrane is ignited, the structure and quality will go down. Vona grows thin, consumes her elasticity and, apparently, decreases and decays. I will look at the whole body of the organism, beginning to compensate for the mill and the growth of the fabric. If the process is pathological, and not natural, then the fabrics become disagreeable - shielding, with the manifestation of infiltration all the way.

The pathology is given - the process of accelerated rhinosinusitis through improper treatment of any of the day. It is a chronic process.

symptoms

Symptoms of this type of rhinosinusitis are similar to those of other types of sinusitis. To the zagalnye signs to lay down:

vision from the nose;
more symptoms in the area of inflamed nasal sinuses;
Intense headache.

For polypous rhinosinusitis, a decrease in scent and post-nasal congestion is characteristic, through the yak it becomes difficult for the nasal dichotomy. Moreover, with the manifestation of polyp, the vessel-sounding drops will be ineffective. In order not to clean up the stink of a stink, so as a winnick is won through a mechanic cross-section through the enlightenment of the nasal passages.

As there is no correct treatment, chronic polypoid rhinosinusitis will manifest itself with the following symptoms:

snakes to the voice, manifest gugnyavism;
seeing from the nose abominable character, Yaki z'yavlyayutsya periodically;
permanently perceived gravity in the area of denunciation;
ruined scent;
lacrimation;
hour by hour, the temperature of thila rises;
headache, if you show what it is, you must immediately take on the painful. If you want to get a pulsation in disguise.

Aggravation of chronic polypous rhinosinusitis is manifested by symptomatology of the process. At the same time, there are signs of intoxication - an increase in the temperature of the body, the headache, the headache.

It means that swelling can be manifested in the area of \ u200b \ u200bthe column, nose and cheek, and auditory function And also you can have a cough, so when you have a lot of mucus, you will gag on the nasopharynx and drag your throat.

cause

exact reasons the diagnosis of chronic polypous rhinosinusitis is not marked on the current day. It is possible to identify factors that provoke the diagnosis of this pathology. Chronic excess sinusitis due to gnarine processes and incomplete treatment of rhinosinusitis provoke the diagnosis of polyp.

Allergic manifestations of rhinitis and fungal infections in the eyes can also provoke growth of polyps.

Other causes of pathology can be:

slump factor;
cystic fibrosis;
destruction of communication processes;
viral pathology;
VIL and іnshі pathologies, as well as suffer from immunodeficiency.

Nybilsch often polyposis rhinosinusitis of the sinus through infectious lesions of the nasopharynx and the paranasal sinuses. The virulent-bacterial nature of the undead, which manifests itself often and at all, does not insist on the necessary treatment, provoking the transition to a chronic form. The continuous ignition process is carried out until the deformation of the mucous ball and the deformation of the slime ball.

It is also a causal factor of the chronic ignition process in the nasal passages and the paranasal sinuses and the anatomical features of the nasal septa. For example, vikrivennya septum in the upper nasal cavities to produce regular mechanical traumatization of the mucous membrane. It can lead to hyperplasia.

Polyposis to provoke also the bristles in the paranasal sinuses and choanal defects.

Yaksho polіpi reached great razmіrіv If you cross the passage through the nasal sinuses, then it is not natural to cleanse it, so it’s a secret that it’s not going to go there. Tse to produce up chronic heat and additional growth of polypiv.

Polypoid rhinosinusitis of winy through the penetration into the organism of such diseases as streptococcus, staphylococcus, chlamydia, pseudomonadi, Candida fungi, etc.

diagnostics

With the manifestation of symptoms characteristic of polypous rhinosinusitis, followed by medical aid... When a patient is sick, take his anamnesis, it is important to carry out palpation in the area of the cheeks, forehead and nose.

Prior to instrumental methods of diagnostics, the following are included:

endoscopic dosage;
x-ray;
computer abo magnetic resonance tomography;

Endoscopy is a way to follow up, with any type of medicine it is possible to assess the mucous membrane of the nose... With rhinosinusitis, it is possible to diagnose the appearance of the nodule, the dermis of the mucous membrane, the manifestation of the appearance of the mucous membrane. And also it is possible to sprinkle the growth of the mucous membrane. Information is transferred to the monitor. These signs are often indicative of polypous nine rhinosinusitis.

X-rays are also informative, so it is possible to see that in some sinuses the igniting process and the polyp is established in them.

CT and MRI are the prices of instrumental diagnostics methods, with the help of which it is possible to accurately diagnose and determine the causal factor of pathology.

Dodatkovo carried out laboratory pre-sultannya - zagalny and biochemical analysis of blood and slaughter.

lykuvannya

In case of polypotic rhinosinusitis, use medications and surgical... Along with it, it is important to see the intelligence, as the reason for this pathology. That is why the activity is growing.

conservatively

Drug therapy includes:

Steroidal antiapalny drugs. Їх indicate in viglyadі drugs іvіtіvіy ії, as a rule, tse sprays.
Antihistamines drugs. The stench dopomagayut znyat nabrya і lowering injected into the allergen.
Antibacterial drugs indicate, in the case of rhinosinusitis, a bacterial nature and sinuses to fester.
Stabilizers of the membranes of the garden cells can also be anti-allergenic.
Immunostimulants. The drug is often used in case of polypotic rhinosinusitis, as polyp is established in case of decreased immunity. A number of drugs are used as antioxidants and drugs for cleansing the body from toxins.

By means of drug therapy, polypous rhinosinusitis є enlargement of the hyperplasia of the mucous membrane and the appearance of new polyps. For a wide range of drugs, hormonal drugs are required.

If medication therapy is not correct, then if there is a visual hirurgic path stink I know to appear.

Glucocorticosteroids are recognized before the operation in order to maximize the swelling in the sinuses and nasal passages, as well as the stench to prevent the establishment of bronchial obstruction. It is even more important that the preparations change the rush of blood to the cich areas of the mucous membrane, with the whole traumatization of the mucous membrane will be less.

surgical treatment

surgical treatment it is necessary for polypous rhinosinusitis. Only in this way you can see more... This stage is important, since only when it is written, it is possible to restore the normal process of the nasal dichotomy. Vidalennya polіpіv see in a number of ways:

laser;
electric strum;
shaver method (behind the aid of an endoscope);
special loop.

Endoscopic surgery or shaver method - tse lucky method, As it stagnates most of the year. At the same time there is a special set of tools and a shaver. This will allow you to spend one hour seeing the polypіv and the correction of the funny character, so as with a whole lіkar you can support the whole process on the monitor.

Hirurgical treatment can be fixed with the main goals of the decal. Among them, there is a visible statement, when necessary, the correction of the deformity of the nasal passages, the correction of the anastomosis is carried out (there is a change in the growth of the sinuses, the rosin of the sinuses is of the gratty type). Medium anomalies when surgical operations There may be an increase in the deformity of the nasal septum, hypertrophic dilation of the mucous membrane of the nasal concha, etc.

Hirurgical treatment in case of polypous rhinosinusitis is not a polyatous involvement, as it helps to change the nasal reaction, or a residual vilification of it is possible only with the help of conservative treatment. During the operation, access to the sinuses is also available for corticosteroids.

Laser visualization is a minimally invasive procedure, with any surgical intervention being minimal, as well as traumatization of the mucous membrane is minimal. Medical tools are not vicious, but it means that the information is reduced to zero. A positive factor in the presence of visible polyps is the rapidity of gutting blood, as a laser can play a role in the loss of judgment.

With visible light, healthy tissue does not appear behind the aid of the laser. This is how the laser cut is precisely directed to the polyposis tissue and the bloodless suture is avoided.

period of operation It is even more important for the patient, when it is necessary to carefully follow the recommendations of the doctor, to prevent the acceleration and relapses. Immediately install a tamponade for the operation of the patient... It is necessary for the bleeding, but the triviality is not to blame for 1 day.

Obov'yazkovuyu brainwave surgery є taking corticosteroid therapy. It is not possible to pick it up sharply, to decrease in steps. During the operation, it is often necessary to use the preparations in the form of sprays, so that the access to the nasal passages and sinuses is already available.

Lykar signifies regularly promising additional sinuses stretching 3-4 times. For a complete procedure physiological breakdown... In the process of manipulation of the sinuses, it is cleared from clots of blood and slime, so that the purchase can lead to a firing process.

Look at the otolaryngologist in the first place two times for the operation to be carried out once a day... With a whole lot of liquor, go to clean the noses, see the picks, as they get there.

When a man is seen, he is guilty of giving proper respect to his health. Be-like the upper hand dikhalnyh nobles blame immediately, because of the accelerated obstruction, and polypoid rhinosinusitis recurs.

Rhinosinusitis is an ailment characterized by inflammation of the mucous nasal and nasal sinuses. Most often, pathology develops in people from 45 to 70 years, but the progression of rhinosinusitis in children is not included. Varto mean that, among the representatives of the beautiful stati, ailment in the spine of development, below the middle of the people.

At the time of progress of the ignition process, the slime of the filling and the provocation. Yak inheritance, due to these anatomical elements, it is crooked, and a specific close of the empty space is formed, in which mucus is accumulated step by step, or gn_ynyexudate. So і vinikє rhinosinusitis. triviality state form sickness - close to one month, chronic form- close to 12 tizhn_v.

Ethiology

In a large number of clinical situations, rhinosinusitis overdual gostra respiratory infection(, Adenovirus abo) As a result, it called for the destruction of mucociliary cleansing and robots, as mucus is produced behind the nose. The secret is to stagnate, and in the new one is actively reproducing pathogenic microorganisms. Tse is the main reason for the progress of the disease.

Rhinosinusitis causes:

bacterial agents, such as, that is;
fungi from the genus Candida abo Aspergillus;
color fungi.

Reasons for the development of ailments:

lowering the reactivity of the organism;
viral infections;
fungal pathology;
pathology of bacterial nature;
trivale of living of the group of pharmaceuticals;
the slump is stretched;
mechanical injuries of the nose of the risky degree of severity;
polyposis of the nose in adults.

dear

Clients are vicious in classifications, based on ethology, interruption, heavy interruption, and localization.

For ethology:

changes;
virgin;
bacterial;
fungal.

For localization zapalennya:

one-sided;
bilateral.

Over the course of:

gostry;
chronic;
relapse.

On the severity of overcoming pathology:

easy form;
moderate;
important.

symptomatology

Necessarily from the form of rhinosinusitis, clinics see backward symptoms, which may lead to progressive ailments in an over-grown child. To such mention:

head b_l of the rising level of intensity;
slime filling;
pledging vuh;
b_l in the localization of the lesions of the nasal sinuses;
nezduzhannya;
weakness;
from the emptying of the nose, there is a secret of a positive character (mucus, gn_y);
mucus can stick on the nasopharynx.

gostra uniform

Gostriy rhinosinusitis is characterized by a twisted clinical picture. Through a few days of progressing ailments in humans, it is indicated that a part of an individual is swallowed up on the side of an individual, an attack like a beat in the head, a decrease in performance. If the symptoms of the formation are not felt for 7 days, then you should be aware of the bacterial infections... In this case, it is necessary to take the patient to the hospital and to carry out antibacterial therapy.

Symptoms of Gastry Rhinosinusitis:

weakness in everything;
lowering the sense of smell right up to the top of the day;
hyperthermia;
head score of the rising level of intensity. The nature of the attack;
googleness;
mucus sticks along the back surface of the pharynx.

Types of symptoms of rhinosinusitis (in lesions in the lesions of the sinuses):

Hostry is characterized by severe pain and severe pain on the side of the uterine sinus. Pain syndrome tends to become stronger for an hour or so to turn around or over the head;
in case of hospitality, it is sickly visions in the frontal area;
with the first symptom є nasal belly;
when people have a strong headache.

Grade GOST Rhinosinusitis:

easy. In general, the symptomatology is not very pronounced. Hyperthermia is indicated to 37.5-38 degrees. If at a given moment to carry out roentgenologic dosage, then on the sign it will be seen that in the sinuses there is a mute pathological exudate (mucous abnormal);
average. The temperature rises to 38.5 degrees. When palpation of the sinuses is carried out, the diagnosis is pain syndrome... Bіl can go to wuha or teeth. Likewise, the patient has a headache;
important. Hyperthermia is swirled. With palpation of the lesions of the sinuses, manifest strong beat... Visually, there is a boom in the area of \ u200b \ u200bchik.

chronic form

Main reasons:

inconsistently spilling rhinosinusitis in the form of hospitals;
ominous alcoholic drinks;
kurnnya;
allergy;
the manifestation of an ailment of the stomatological sphere.

The main symptoms of pathology:

head b_l;
lower scent;
from the nose, there is a gn_yny exudate;
nasal congestion;
pidvischene slosovidlennya;
googleness;
hyperthermia;
the severity of the individual from the side of the localization is hot.

Polypoid rhinosinusitis

Progression of polypous rhinosinusitis often occurs in people, the reactivity of the organisms of which is significantly reduced. This is also due to the fact that in the course of the early days, in the course of the development of the disease, it was established that the development of pathological diseases in patients, in those with a decrease in the concentration of immunoglobulin G.

Mechanism of development of polypous rhinosinusitis of the onset:

for injecting foreign agents, allergens and aggressive chemical agents. slime nabryak speech;
step by step epithelial fabrics are formed, and on them specific virity is formed - polypy.

In general, there is only one thing - the operation. Ale varto immediately means that most often it is difficult to get sick from acute illnesses, and it is possible to provoke an attack of breath. But all the same it is necessary to carry out it, so that the patient can no longer be lost.

sinus rhinosinusitis

The reason for the development of nasal rhinosinusitis in adults and children is the pathogenic activity of bacterial agents in the epithelium of the nose and sinuses. Zazvychay to this to produce traumatization of the nose. One correct method of treatment is antibacterial therapy. In order to accurately confirm the diagnosis, it is necessary to carry out the seeding in the sinuses on the living middle ground, to find the right disease (staphylococcus, streptococcus, etc.). The clinker is twisted even more yaskravo with a great variety of illnesses. The following symptoms appear:

hyperthermia to high digits;
bends and intoxications syndrome;
strong dentition;
decreased appetite;
disturbed sleep;
swelling and soreness on the side of the localization of heat;
vidіlennya gnіjnogo eksudatu;
b_l in navkoloslobovyh members.

The qi form of pathology is most not safe, and it is often accelerated by abscesses. The treatment of ailments was carried out on a weekly basis in the stationary minds, so that patients could permanently monitor the patient's status and prevent the progress of the patient’s slowdown. Therapy includes antibacterial drugs, Immunomodulators, mucolytics, antihistamines of lykarski zasobi.

allergic form

The pathology of progress is pouring into the organisms of people of young allergens. Symptoms of offensive ailments:

the ear of the eyes;
display on the shkіrnom pokrivі elements of the visip;
from the nose can be seen a glimpse of mucus.

catarrhal form

Catarrhal rhinosinusitis is an ailment characteristic rice such as inflammation of the epithelial tissues of the nose and sinuses without seeing a secret. It is possible to say, that the whole undead is white, so how is it that it is victorious on the floor.

symptoms:

Intoxication syndrome;
disturbed sleep;
loss of scent;
pidvischene slosovidlennya;
a patient of a certain meaning, when in the nose empty there is a feeling of bite and dryness;
navkolonosovyh sinuses napryakayut;
hyperthermia.

Catarrhal rhinosinusitis is of an even more insecure form, as without a prompt and adequate treatment, it can be alleviated by pathologies of the upper diabetic pathology, meningitis or an abscess to the brain.

vasomotor rhinosinusitis

Vasomotor rhinosinusitis starts to progress on aphids of colds. The striking can be either one-way or two-way. Older and older children show the following symptoms:

undead with a savage exudate. In the world of progression of vasomotor rhinosinusitis, exudate has a change in character - wine grows green;
hyperthermia to high digits;
Intoxication syndrome;
disturbed sleep;
weakness.

The Danish process cannot be started, as it can be chronized without adequate treatment. It was necessary to fix it all at once, as first signs of such rhinosinusitis appeared in children and grown-ups, and in the future they did not spend a lot of puncture of the sinuses.

diagnostics

The otorhinolaryngologist is responsible for diagnostics and treatment of ailments. The standard plan for diagnostic visits includes:

patient experience and assessment of symptoms;
palpation of the cheekbones and forehead (for the appearance of ailments);
rhinoscopy;
otoscopy;
pharyngoscopy;
microbiology before being seen from the nose exudate;
radiography;

come in

Likuvannya stay in stationary minds and under the control of the doctor. Samolіkuvannya is unacceptable, as it is possible to provoke the progress of the unfailing acceleration. Likarі vdaayutsya yak to conservative, so and to operative methods of treatment. The vibe of the technique is to lay aside the severity of the pathology and peculiarities of the patient's organism.

drug therapy:

antibiotics;
spray with antibacterial components;
antihistamines;
corticosteroids;
dots in nis with vessel-sound and anti-abdominal components;
immunomodulators;
mucolytics;
fever-lowering;
antibiotic drugs.

Surgical methods of treatment:

punctuation of urazheniye navkolonosovyh sinuses;
visible in the place of the sinuses behind the auxiliary YAMIK catheter.

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GOU VPO First Moscow State Medical University IM. I.M. Sechenov

Department of Otorhinolaryngology

History of ailments

viconavets:

Dzhanchatova B.A.

vicladach:

Kochetkov P.A.

Moscow 2013 rik

1. PASSPORT PART

PIB: Albina Grigorivna M.

vik: 59 rock

Pidloga: female

profession: pensioner

Date of operation before the announcement: 23.09.13

Diagnosis when appropriate: Chronic polypoid rhinosinusitis, stage of aggravation.

skargi: Difficulty in the nasal movement, movement through the mouth, dryness in the mouth and vision from the empty nose white color mucous consistency, stike obstruction of nasal movement and nasal congestion; pain in the projection of the sinuses; I will lose my scent; discomfort in the nose, headache.

2. THE HISTORY OF ZHVORYUVANNYA (Anamnesismorbi)

chronic polypous rhinosinusitis septoplasty

Basically ailments: With a stretch of 15 years of ailment, one can get a nasal decay, a nasal congestion, a nasal congestion, a decrease in scent, and a small amount of vision. With a stretch of the first 7 years of age, the symptoms of a mali seasonal character due to acute aggravations in the autumn-spring period, triviality of 2 months each with the need for an annual growth of mussels ship-sounding drops... I didn’t go for medical aid. Since 2006, the symptoms have become stiff. Vinikla the need for a generic storage of ship-sounding drops in the evening. In 2012, the rock turned into the Department of Otrіnolaryngology of the First Moscow State Medical University ім. I.M. Sechenov, during the anterior rhinoscopy and computed tomography of the nasal emptying and nasal sinuses of the boule, the number of polyps of both nasal passages was revealed. Bula vikonana double-sided operation Polypectomy. Pislya operatsii nosove dichannya vidnovilosya. Bulo is recommended to administer intranasal corticosteroids for 2 aplications into the skin, 2 times a day. Helpful death from the sickle 2013 to fate, since the death of the nose and the need for the use of muscular ship-sonic dribbles has already been lost.

3. STORIA LIFE (Anamnesisvitae)

It was born in the term, grew and developed consistently until the beginning. Physics i mental development from one page did not come. Osvita vishcha is economical. Professionals of schooling are reserved.

Family history: Change. There are two children.

Courtesy, implantation of alcohol and narcotic drugs is reserved.

Transferred illnesses: child infections (vitriana vispa, rubella). ГРВІ - up to 2 times per pik.

Allergologic history: Allergic visipu, angioedema nabryak (nabryak Kvinke), kropivyanka, sinna fever, anaphylactic shock in case of early grub Lykarskiy rechovin I will lock it down. Slump: not tight. Sister - 44 rocky, healthy. Brother - 51 pik, health. Children: syn 31 rik - health, syn 35 rokiv - health.

Status praesens objectivus .

Zagalny camp zadovilny. The position is more active. The evidence is clear. The statues are correct. Shkirni, be clean. The small lymph nodes did not get bigger. Dikhannya vesicular. Tony's heart is rhythmic, muffled. Arterial vise 130/80 mm Hg. Art., the frequency of the heart is very 72 per chilin. They live soft, painless.

ENT organ status :

NOSE: Nosove dikhannya is not difficult. The partition is vicious. The middle nasal path of evil is obturated with great polyps. Slime shell rozhev nose emptying, with cyanotic view. At the empty nose mucous vision.

Pharynx: Mucous membrane of the posterior stinka of the horny pharynx. Migdalini behind the arches, welded to them, the vision of migdalin is dumb.

Nasopharynx: With the posterior rhinoscopy, the dome of the nasopharynx, and the ear of the auditory tubes, is visible.

Larynx: The front of the larynx is not changed. The voices of the ringing of a white color, equal on the edge, the excursion is symmetrical, in general. There is no space under the fold.

WOOHA: AD-AS. In the ear canals vid_leni nemaє, drums overflowing gray color. Check points read

hearing	Post-treatment of the vestibular apparatus
			Spontaneous sub'єactive and obsessive vestibular symptoms during the day
	whisper mov
	Rozmovna mov
	Gucci Mova O. Weber O. Federici		Zapamorochennya, nudota, bluing is dumb. Rivnovaga is not destroyed
			Spontaneous nistagmus
			Finger-nose test in norm. The pose of Romberg has a stik.
			adidochokines during the day
Between the norms		Between the norms	Pressor test is negative.

Zagalny camp.

Zagalny camp is very good. The evidence is clear. The position is more active. Viraz revealing the calm. The temperature is 36.6 C. The temperature is 164 cm, the carriage is 65 kg.

shkirnіtwistingand: Extravagant vologosti and color, clean. Zabarvlennya visible mucous blood-rozheva. nіgtyovі plates extravagant form.

Pediatric fat cells: rozvinena amicably. Visible rags (on guises, homosexuals, in the region of kryzhiv) are dumb.

Lymphatic system: Lymphatic universities(Submandibular, pillary, inferior, anterior and posterior, supraclavicular, pidclavicular, inguinal, cubital, peri-umbilical, inguinal, subclavian) palpate without distant.

Myazova system: rozvinena pomіrno, symmetrically. Hypertrophies and atrophies of the surroundings were not revealed. Pain in palpation painless, normal tone.

People's estates: Visible pathological changes are not revealed. Rukhs in vilny, painless. The shape does not change. An abundance of active and passive savings. The temperature adjustment of the shkiri over the slopes does not occur.

Dikhannya system:

look around breast cancer: Breast cell is symmetrical, normostenic type, cylindrical form. frequency dikhalnykh rukhiv in calm 17 in 1 chilin. Zadishki are dumb. The rhythm of the dikhannya is correct.

Palpation of breast tissue: painless, elastic. Golosovetremtinnya: to start with the same force over symmetrical lungs. Vognischevikh vocal tremtynnya not revealed.

Auscultation of the leg: the dyhannya is vesicular. The bitter dichal noises (wheezing, crepitations, the noise of rubbing pleurisy) does not occur. Bronchophony is not changed, however, on both sides.

Blood circulation system:

When looking at the shija, the pulsation of the sleepy arteries is normal (up to the middle of the sternocleidomastoid nipple-like muscle). The pulsation of the jugular veins is not visible. Percussion between the heart in the norm.

Auscultation: tone muffled, rhythmic. The noise of the heart is not audible. Noise rubbing the pericardium does not appear.

Doslidzhennya pulse: symmetrical on both hands. Pulse deficiency is mute. Frequency of 70 per chilin, zadovilnogo napovnennya, altogether tension, normal visoti, amplitude, speed and magnitude.

Arterial vise 130 і 70 mm Hg. Art. on both hands.

Etching system.

Mova vologii, no deposit. The mucous membrane of the black-rozhev. Gums: erysipelas, do not bleed. Teeth: sanuwati. Kovtannya vilne.

Doslіdzhennya belly: take care of the fate in the act of dichannya. Rounded form, no increase in obsyag.

Percussion of the abdomen: the tympanic sound of the rising step of the bend is heard in all eyes.

Palpation of the abdomen:

They live soft, painless. The tension of the musculature of the anterior cervical wall is not revealed. Symptom Schotkіna-Blumberg negative.

Pre-treatment of the stove: to the cordon and the development of the stove in the norm.

Palpation of the spleen: not palpable.

Human Anatomy Models.

Hyperaemia and swelling in the area were not revealed at all. Sechovipuskannya vilne, painless. Pasternatsky's symptom is negative from both sides. Nirkas are not palpable.

Endocrine system.

Sprague is dumb. Ovolosinnya for female type. Tremor of fingers, stolittya, move dumb. Thyroid gland not bad. Symptoms of Shtelvag, Graefe, Moebius, Mari negative.

Neurological status:

The patient is in svidomosty, headache, tedium, blues dumb.

Meningeal signs: Kernig's symptom (straight, perehresny), Brudzinsky's symptom (upper, middle, lower), rigidity of the muscles of the potential - negative.

Additional clinical and laboratory reports:

1) Foreign and biochemical analysis of blood.

2) X-ray of the nasal and sinus emptying;

3) CT scan of the emptying of the nose and sinuses.

4. RESIDUAL DIAGNOSIS OF THE I YOGO PRIMED

Viciousness of the cartilaginous part of the nasal septum with the appearance of the left. Chronic polypoid rhinosinusitis (unilateral), stage of aggravation.

Diagnosis established at the office:

· Skarg patient (difficulty in nasal dyhannya, nasal congestion, rhinorrhea, cough, sputum, bile in the projection of the sinuses, head bile, reduced scent).

Anamnesis (with a stretch of 15 years of ailment to a ruptured nasal disorder, nasal congestion, reduced scent, low vision)

Danih look around the ENT organs (the nasal dichotomy is not difficult, the septum is crooked, the middle nasal head is obturated with great polyps, the mucous membrane rozhev nose emptying, with cyanotic view, mucous vision in the nose emptying)

· Danih dodatkovyh methods of dosage (CT ONP): vikrivennya nasal septum, darkening of the nasal sinuses ??

5. Differential diagnosis

Gniyny rhinosinusitis - gniy aspirate from emptying sinuses (the patient does not suffer from it).

Good puffy affirmation - deformation and destruction of sinuses on CT.

Malicious, pooh-like affirmation - deformation and destruction of sinus stinas on CT scan.

6. PLAN LIKUVANNYA

Endoscopic unilateral polypectomy, septoplasty.

The operation of the visualization of the nasal emptying is carried out under the backward abnormal anesthesia. Operation of the field in the hanging field for additional surgical instruments or a laser. At the same time, it is carried out from the inner surface of the nasal emptying, so that there are no scars during the operation. During the first hour of the operation, the nasal sinuses are also washed, and the re-establishment of the nasal emptying polyps is prevented. For the soreness of bleeding from the wound, during the operation, gauze tampons should be injected into the nasal noses. Through a few days the stench is seen. During the operation, antibiotics and analgesics are recognized. Correction of the nasal septum, which, as a rule, works endonasally. Razrіz shy in the middle of the nose, the scar is not visible. Operation on the correction of the nasal septum of the cleft in the visible damaged cartilage and cyst sections. At the same time, there is a mucous membrane covering the nasal septum, and during the operation on the septum, do not overdo it. If you have a recurrence, then a trivial course of treatment with corticosteroids for muscle soreness is indicated; beclomethasone, flunizolide, mometasone.

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describe

At the end of the destruction of the local authorities, the immunity of the trivial excess of rhinosinusitis provokes the growth and growth of the mucous membrane of the nasal emptying and the nasal sinuses due to the formation of polyps. Qia ailments evolve to develop in parallel with the failure of other illnesses and supervise unacceptable cruel visions. More often chronic polypous rhinosinusitis is diagnosed in representatives of the cholovic status.

specialties

polypy є good chicks... Їх viniknennya will be explained by the appearance of ignited fires, which are hostile m'yak_ fabric sinuses. Such a pathological camp of pereshkojaє penetration living talk, As a result of what is the vitality and loss of plasticity of the mucous. Organism will turn to the first camp. For a rakhunok in the nasal empty space, new shades of fabric are replaced with viton. In the world of progressing pathological stun in the sinuses, there are drop-shaped polyps, reminiscent of infiltrate.

This kind of chubby can be generated in a variety of ways. The stench is scaling on the walls of the sinuses, flapy groups. In the bag, the penetration of the day and age will be ruined there. And outside the blockage of the nasal emptying, I snort people to inhale and vidihati to drink through their mouths.

On the other hand, chronic polypous rhinosinusitis (according to ICD-10 code J01), unimpressed on a typical picture and cause development, is not a problem. On the basis of the named pathology, with sinusitis, abnormal swelling appears in the area

Causes of the blame

Exactly change your mind before the development of chronic polypous rhinosinusitis is not yet visible. In the midst of friendly minds, fakhivtsi see advances:

cystic fibrosis;
recession;
chronic sinusitis with gn_ine processes;
fungal damage to organism;
overwhelming sensitivity to salicylic acid;
allergies, including rhinitis;
not forcibly rhinosinusitis in the form of rhinosinusitis.

Qia pathology infectious and develop as a result of an infected organism:

rubbish;
streptococci;
pseudomonads;
fungus Candida;
stafilokok.

pathogenesis

It is obvious, through such a great number of provocative officials, that the symptoms and signs that accelerate the diagnostics of the disease are quickened. To that, I have a very important picture of the described ill-health of the nobility in detail.

Igniting the lights in the nasal emptying and the polishing itself through the inflow of such officials:

hypothermia;
the presence of fistulas maxillary sinusі mouth emptying;
weakening immunity;
caries;
hypovitaminosis;
reflux esophagitis;
vikrivennya nasal septum.

In addition to this, the hormonal factor in the pathogenesis of chronic polyposis rhinosinusitis will play a role. Destruction in the robotic endocrine system and unknowingly lead to weakening of the immune and diseases of the functioning of the organs.

Up to the number of minds that experience the birth of chronic polypous rhinosinusitis, shkіdlivі calls, Yak kurinnya and inhalation of dental chemistry.

ailment

Chronic polypoid rhinosinusitis (according to ICD-10 code J01) is categorized according to the severity of interruption, in the least sense of the reasons for having a new solution.

So, in fallowness in the oblast, the distribution of burial is one- and two-sided. And from the view of the pathology, the pathology lasts on the onset of the view:

virusna;
bacterial;
fungus;
zm_shana.

For the nature of the intermittent rhinosinusitis, it grows in the middle, light and important.

key picture

A cob symptom is to talk about the manifestation of a new affair in the nasal emptying, to get into trouble with difficulty. Qia is a sign of supervising and next to them:

goognaviy;
pogirshennyam scent;
I will appear mіgrenі;
see discomfort in the area;
unacceptable smell mouthwash;
harsh visions from the nose;
inappropriate views behind the ladies.

In the world of progression of pathology, and when there is a daily malnutrition, anomalous new conditions expand in the empty noses. At the stage of the ailing one is seen slid in a vice in the nose and presence there of a foreign subject. In the nearby maybutny, if the patient does not press into the zhodnyh diy, win zumin dikhati viklyuchno through the mouth.

ymovirni accelerated

The history of ailments in chronic polypous rhinosinusitis is a trivial developmental breakdown in the robotic heart-vascular system of the patient, as well as in a new progressive tachycardia. And it is seen as a result of a reliable lack of quality. In some cases, there are problems and problems with partners. And after zagalny nezduzhannya ailments can be both drastic and confrontational.

When there is a need for therapy, there may be a decrease in speed, including:

visibility or loss of appetite;
sisneve hunger for the brain, as a result of which there is a decrease in patronage, memory and concentration of respect.

Chronic polypous rhinosinusitis is not safe to be scared in that step in the nasal sinuses to accumulate nas, which is accepted as a friendly mind for the propagation of bacteria. As a result, microbes expand on the adjacent organisms, and they can help you to see them. In the case of the pathogenic microflora, the pathogenic microflora penetrates into the brain through chronic infectious polypoid rhinosinusitis, through which meningitis develops in the patient.

іnshі heritage

Yak accelerated can also be found in subperiosteal abscess, sepsis, rhinogenous sinus thrombosis. When it comes to risik for healthy organs, then the system is strong up to:

pseudo-swelling of the internal orbits;
dacreoadenitis;
abscess stolittya;
conjunctivitis;
retrobulbar neuritis;
panophthalmitis;
parall_chu full-time apple.

In addition, the disease itself can be accelerated by paratonsillar abscess and otogenic sepsis. As a result, severe rhinosinusitis can provoke important pathology, which in 25% of cases can lead to a lethal result.

diagnostics

To diagnose a patient with a sprinkler, but a patient's forehead with a palpation path, in order to give a direction to zagalny analiz blood. In addition, there can be signs of additional information:

endoscopy;
rhinoscopy;
biopsia;
rhinomanometry;
microbiological analysis;
radiography.

Another option is to ensure the best results. Endoscopy is used in a minimally invasive procedure, as it allows the evaluation of the mucous membrane of the nasal emptying and adherent tissues.

Computer tomography is used as a head diagnostic technique and an instrument for prompt engagement.

To assess the microbiological flora of the nasal sinuses, biochemical and biological analysis is used.

In the process of laboratory diagnostics in patients with rhinosinusitis, there is a change in blood storage, including aggregates of platelets, a high level of fibrin and sorption of the power of erythrocytes.

With the help of the fact that the disease is characterized by signs that dominate and in those pathologies, it is possible to differentiate diagnostics. And the strategy of therapy is developed individually at the premises of equipment and laboratory devices.

Treatment of chronic polypous rhinosinusitis

To relieve the described ailments, two methods are used:

conservative;
surgical.

However, there are numerous indications of chronic polypotic rhinosinusitis without prompt involvement, which does not allow for a permanent reduction. implantation lykarsky zasobiv Yes, there is a possibility of galvanizing the progress of pathology and making it look like sheer puffs. I most often conservatively victorious for the improvement of the triviality of the remission. In all other patients, patients are directed to the operation, in the process of which a visible new treatment is carried out in the nasal sinuses.

Current medicine is known to be ill with such a diagnosis of the consumption of drugs, so that we can safely diagnose the growth of growths. In the future, the new establishment is vivodia with the body of the natural path.

In addition, for chronic polypoid rhinosinusitis, it is possible to go to the systematic nasal sinus repairs by means of a wide range of solids or special methods, on the basis of "Kvix" or "Aquamars". These preparations give the ability to change the purchase, thus reducing the risk of development and growth of pathogenic microorganisms.

Drug treatment

Obov'yazkovuyu mental therapy effective therapy to take into account the reasons for becoming ill. At the same time, it is necessary to unify the implantation of non-steroidal anti-inflammatory drugs. Moreover, it is even more important to capture the allergens penetrated into the nasal emptying. Drug therapy is stored in decile stages:

Mistsev anti-fiery zasobi. For lіkuvannya rhinosinusitis stagnates, as a rule, corticosteroids, for example: "Rinoklenil", "Beconase" and "Aldetsin". When a new preparation is made, it will be reviewed in a couple of days. And for the sake of being stuck, the medication is not consumed in the blood-bearing vessels, the side effects of such methods of treatment appear in the edge. All through a few days after the introduction of the significant drugs in the patients, the patients received the value of the polyphenia.
Antigistamіnnі zasobi. When the pathological stanis is described, medications of another generation, analogous to "Cetirizin", "Fexofenadin" or "Loratadin", are used. Tsi preparations bring the same quick result. It should be noted that the stench of the same rank is not infused into the central nervous system, Zavdyaki chomu not viklikayut zvikannya. Antihistamines help prevent and absorb nasal emptying and fight against spasms of smooth mucous membranes.
Stabilizers of membranes new solution. One of the most popular drugs from the whole category is "Ketotifen". There is a galvanic effect of histamine receptors, for the reason why the rizicum of eosinophilic substances in the nasal emptying is included.
Immunostimulants. Necessary for out-of-town entertainment immune system... The managers of the victorious know the infectious diseases viral zvoryuvannya... In addition, the preparation will help you to get rid of the thickening and dryness of the mucous membrane.

Hirurgicne involvement

Operations for chronic polyposis rhinosinusitis may be due to microdebrider shaver and muscle anesthesia. The attachment, except for an empty tube, is covered with a special endoscope with a microcamera, which gives you the opportunity to control all manipulations. The machine pislya hit in the nasal emptying flap, a negative grip, when the working handle with dibnie blades sniffs until it swells.

pislya surgical engagement cotton tampons are injected into the nis obov'yazkovo, I bleed. In addition, the patient in the form of rehabilitation therapy is assigned drugs that help to prevent recurrences.

visnovok

For rhinosinusitis treatment and prevention, you can go to the recipes folk medicine... For tso you can be quick steam inhalations over boiled cartopley, the famous "Zirochka" balsam, a chapel or menthol. You can vikoristovuvati і a compressor with mixed eggs, rosіgrіtogo rychkovy sisk or sea salt.

In case of elimination of pathology, step brothers to respect the rules:

a sick person needs to go through a test for an allergy for the emergence of a witch;
bazhano systematically dotrimuvatisya special feeding regime;
sudinozuzhuvalnі medications zaboronyaєatsya zastosovuvati more than tyzhnya.

Cystic polyphysiology of rinosinusity. First look at a sick person when

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cause

diagnostics

lykuvannya

conservatively

surgical treatment

Ethiology

dear

symptomatology

gostra uniform

chronic form

Polypoid rhinosinusitis

sinus rhinosinusitis

allergic form

catarrhal form

vasomotor rhinosinusitis

diagnostics

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specialties

Causes of the blame

pathogenesis

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key picture

ymovirni accelerated

іnshі heritage

diagnostics

Treatment of chronic polypous rhinosinusitis

Drug treatment

Hirurgicne involvement

visnovok