Common syndromes of nose diseases

At various on aetiology and pathogenesis diseases of a nose and paranasal sinuses there are a number of the general clinical syndromes reflecting infringement of functions of this system and defining the basic complaints of patients.

[1], [2], [3], [4]

Causes and pathogenesis of primary inflammation of the organs of the rhinosinus system

After birth, the baby breathes mostly through the nose. Only with congenital defects in the development of endonasal formations (nostril stenosis, atresia of hone, etc.), nasal breathing is impaired. However, in a large number of newborns, nasal breathing is still impaired, which causes a number of general and local deficiencies in the development of the child that result from chronic hypoxia, but because of nasal breathing and permanent sagging of the lower jaw. In these cases, after primary rhinitis in the first years of life, children develop excessive secretion and, as a consequence, hypertrophy of the nasal mucosa and interstitial tissue located among the venous system of the nasal concha. Simultaneously, there are also vasomotor disorders, which initially are of a periodic nature, and then become permanent. Under these conditions, the local immunity of endonasal structures is reduced, barrier functions are broken, resulting in the saprophyte microbiota becoming pathogenic, which leads to the onset and generalization of the inflammatory process, which often extends to the entire lymphoid system of the upper respiratory tract. The nasal secret, containing pathogenic microorganisms, penetrates into the paranasal sinuses, trachea and bronchi, which often leads to allergization of the body and the development of asthmatic syndrome.

The causes of primary inflammatory diseases of the rhinosinus system in early childhood are artificial feeding, infections of childhood, improper hygiene of the child, for example, isolation from the cold factor or non-safe attitude to the child. It is known that the cold is an effective means of tempering the body with its general effect, but inhaling cold and moist air disrupts the immune function of the upper respiratory tract and facilitates the transformation of the saprophyte microbiota into a pathogenic one. Of the other causes of nasal respiratory disorders in children should be noted curvature of the septum of the nose, hereditary syphilis with nasal localization, gonococcal runny nose, foreign bodies, hypertrophy of adenoid tissue, angiofibroma of the nasopharynx, banal inflammatory diseases,

[5], [6], [7], [8], [9], [10]

Nose respiratory function disorder

This syndrome includes the open mouth, noisy nasal breathing, poor sleep, the presence of defects in the development of the maxillofacial region, lag in the development of the child, etc. So, with a prolonged disturbance of the respiratory function of the nose, children are observed not only violations in the development of the maxillofacial skeleton, but also disorders in the development of the spine (scoliosis), the humeroscapular region, and deformation of the thorax. Characteristic are also changes in the timbre of speech (closed nasal), difficulty in engaging in vocal, physical education, violation of olfactory and taste functions.

Violation of nasal breathing can cause a number of reflexogenic symptoms, such as vasomotor dysfunction, metabolic changes (CBS), hemopoiesis, etc.

The syndrome of vascular disorders

The vascular plexuses of the nose and the vegetative fibers innervating them react sensitively to changes in the overall vascular tone of the body and especially the vessels of the brain. The superficial location of the vessels in the nasal cavity, weakness of their walls often causes nasal bleeding in conditions such as hypertensive crisis, with violations of the coagulation system and other blood diseases. In addition, the violation of the regulation of vascular tone from the side of trigeminal-vegetative innervation often causes the emergence of such conditions as increased vasoconstriction or dilatation of vascular endonasal plexuses, which is often correlated with similar conditions of the cardiovascular system. As a rule, the violation of vasomotor reactions in the structures of the nose can be caused both by mechanical and physical factors (irritating thorn of the septum of the nose, cold air, etc.), and by the influence of internal adrenergic factors caused by activation of the sphere of emotions or diseases of the adrenal glands. The initial stages of these conditions are characterized by a change in the constriction and expansion of the vessels, after which the stage of paresis of the vascular wall begins, its permeability increases, the edema of the interstitial tissue arises, and its organization into the sclerotic tissue. This condition is called hypertrophic rhinitis.

The syndrome of disturbed vascular tone of the endonasal structures is characterized by a periodic and then permanent disturbance of nasal breathing and all other consequences of this condition described above.

Syndromes of impaired secretory function of the nasal mucosa

These syndromes can be manifested by increased or decreased secretion of mucus by the glandular apparatus of the nasal mucosa, which is under the double influence of the parasympathetic and sympathetic nervous system. The predominance of the influence of the first causes increased activity of the glands, manifested by the so-called rhinorrhea, the predominance of the second - dryness and subatrophy of the nasal mucosa.

A simple rhinorrhea of an absolutely and non-allergic nature can arise when some toxic substances are eliminated from the nasal mucus, in patients suffering from kidney failure, with gout, iodine intoxication, etc. Such a runny nose is not of a paroxysmal nature, runs for a long time and is not accompanied by sneezing, violation of nasal breathing and other signs characteristic of acute inflammatory, vasomotor or allergic rhinitis. The amount of mucus secreted can be different and in some cases can reach 1 l / day or more. Nasal discharge is transparent, colorless, practically does not contain uniform elements, does not thicken and does not form crusts.

Treatment is effective only when determining and eliminating the cause of the disease. In general, general health-improving physiotherapy methods are used, they adjust the function of the digestive tract, do not recommend smoking and eating sharp meals, restrict the use of table salt and protein-rich food. In some cases, prescribe per os extract of belladonna, calcium chloride, antihistamines.

Syndrome of dryness of the nasal mucosa, as a rule, is a consequence of the transferred early ulcer rhinitis (diphtheria, scarlet fever, etc.) or incorrectly performed surgical operations on the nasal cavity structures (repeated burning of nasal conchaes, their radical removal). The causes of this syndrome were called endocrine disorders (Graves' disease). Bright manifestations of dryness and atrophy of anatomical formations of the internal nose, including the bone skeleton, are observed in the lake.

Treatment is exclusively palliative, determined by the state of the nasal mucosa and the cause of its dryness and atrophy.

The syndrome of nasal liquorrhea

Liquorrhea is a prolonged discharge of cerebrospinal fluid from the natural openings of the skull and spine, with mandatory violation of the integrity of the solid meninges. By source of origin, liquorrhea is subarachnoidal and ventricular. As a result of gunshot wounds to the skull, this syndrome is observed in 6.2% of cases. Most often, CSF occurs with basal or parabasal wounds, especially if the area of the paranasal sinuses is affected (latticed bones, etc.) with violation of the integrity of their walls bordering the brain and rupture of the meninges. Recognition of liquorrhea is not difficult if the dressing around the blood stain has a halo of a transparent yellowish liquid. It is more difficult to establish leakage of cerebrospinal fluid through the nose, especially if it is released only by sneezing, straining, lifting the gravity, etc., or if the cerebrospinal fluid enters the nasopharynx and is swallowed. Often, the presence of liquorrhea is established when air is detected in the fistula by X-ray of the skull or CT of the brain.

There are two types of nasal liquorrhea - spontaneous and caused by mechanical damage to hard meninges (surgical intervention on the sinus, frontal and sphenoid sinuses, trauma with a fracture of the base of the skull and gunshot wounds). Liquorrhea, both spontaneous and caused, is a serious condition that contributes to secondary infection of the meninges and is difficult to cure.

Spontaneous nasal liquorrhea is a rare disease caused by the congenital disruption of the integrity of the trellis plate and the surrounding solid meninges. Spontaneous nasal liquorrhea occurs periodically for no apparent reason and may temporarily cease. It can occur after physical exertion, with certain diseases of the brain accompanied by venous stasis and increased intraocular pressure.

The nasal liquorrhea can simulate a liquorrhea that occurs when the ear is injured, when the spinal cord enters the middle ear, penetrates the nasopharynx through the auditory tube and from there, with the head tilted, into the nasal cavity.

Treatment

In case of acute emergence, antibiotics of a wide spectrum of action (intramuscular and subarachnoid) are prescribed; conduct dehydration therapy, lumbar punctures with partial replacement of the cerebrospinal fluid by air (embolism of the fistula). The patient is given an elevated position in the bed, contributing to a lesser flow of cerebrospinal fluid. Massive loss of cerebrospinal fluid leads to a decrease in the ventricles and a severe syndrome of cerebral hypotension. With persistent nasal liquor, resort to surgical treatment.

Syndromes of sensitivity disorder of the nasal mucosa

The innervation of the nasal mucosa is represented mainly by the trigeminal nerve and the fibers of the VNS. The triple nerve provides temperature, tactile and pain sensitivity and plays a crucial role in providing a number of nasal protective functions and the normal state of the nasal mucosa. Lesions of the trigeminal nerve (syphilis, tumors, traumas, etc.) can cause both impaired sensitivity of the rhinosinus system and trophic changes in the nasal mucosa.

Sympathetic innervation proceeds mainly from the carotid plexus and from the upper cervical sympathetic node, parasympathetic innervation follows to the nasal mucosa in the nerve of the pterygoid canal, which brings parasympathetic fibers from n. Petrosus major. Both departments of the VNS take part in the innervation of the glands, all internal organs, including the upper respiratory tract, blood and lymphatic vessels, smooth and partly striated musculature. The sympathetic system innervates all organs and tissues of the body and provides a generalized activating effect on them on the basis of adrenergic mechanisms. Hence, its vasoconstrictor effect on the vessels of the nasal mucosa. The parasympathetic nervous system regulates the activity of the internal organs, in particular the secretory function of their glandular apparatus (including the upper dysfunctions), and has a vasodilating effect.

Syndrome of anesthesia of the nasal mucosa is characterized by loss of all types of sensitivity and loss of sneezing reflex. This syndrome is caused by the defeat of the trigeminal nerve at various levels, including its sensory terminals located in the nasal mucosa. The latter takes place at the oceans, deep forms of banal atrophy of the nasal mucosa, the effect of harmful industrial aerosols and gases. With these forms of anesthesia is not always complete, some types of sensitivity in a reduced form may persist. Total anesthesia occurs only when the trunk of the trigeminal nerve or its node is completely damaged by such pathological processes as syphilitic pachymeningitis, purulent meningitis of the posterior cranial fossa, tumors of the MMU and brainstem, traumas and injuries of the corresponding areas of the skull, etc. In these cases, the function not only trigeminal nerve, but also other cranial nerves located in the posterior cranial fossa.

Syndrome of hyperesthesia of the nasal mucosa is usually due to the presence in the inhaled air of a sudden appearing irritant factor or acute inflammatory process, allergic crisis, sometimes the presence of IT.

Reflex reactions of the nasal membrane

Due to the high sensitivity of the shell, the nose can be the source of numerous reflexes at a distance, sometimes simulating various pathological states of "unclear etiology." These conditions can concern the bronchopulmonary system (asthmatic syndrome, "causeless" cough, bronchorrhea, not caused by any inflammatory process, etc.), gastrointestinal tract (belching, hiccups, dysfunctions of the gatekeeper, manifested by heartburn, etc.), cardiovascular system (arrhythmias, arterial hypertension, angina pectoris, etc.). As an example of the presence of a trigger ("trigger") zone in the nasal mucosa that caused vestibular function impairment, one can cite the observation of Ya. S.S. Temkin (1965), which linked their occurrence with the traumatic curvature of the septum of the nose. After elimination of this anatomical defect, vestibular crises ceased. An analogous case of angiogenic epilepsy was also described. DI Zimon (1957) believed that RNH ZN owes its origin not only to the inflammation of the "posterior" paranasal sinuses, but also to the reflex spasm of the arteries of the ZN, whose source is the pathological states of the rhinosinus system.

Numerous studies have established that the starting zones of pathological reflexes are various morphological changes in the nasal cavity (curvature of the septum in the upper parts of the nasal cavity, hypertrophy of the central nasal concha, especially its posterior part innervated from the system of the pterygoid node). The irritation of these zones leads to spasm of the smooth muscles of the lower respiratory tract and to the phenomena of asthmatic syndrome. Among asthmatics, in 10% of cases, polyposis of the nose is observed, which, it is believed, can lead to irrigation of the trigger zones of the nasal membrane.

Treatment, as a rule, is persistent only when establishing the cause of the distant syndrome and its elimination, in particular the "complete" sanation of the rhinosinus system. Palliative methods include anesthetic blockages of the nasal mucosa: nasal septums, areas of the middle nasal shell, ager nasi (an area slightly higher and anterior to the central nasal shell).

Syndromes of distant complications

In diseases of the nasal cavity, remote complications are possible, such as inflammatory diseases of the ear, lymphadenoid system of the pharynx, larynx, trachea and bronchi, tear ducts and a number of internal organs.

Often arising as complications of pathological processes in the nasal cavity in children bronchopulmonary diseases simulate pulmonary tuberculosis, but, on the other hand, it is found that it is the disorders of nasal breathing that contribute to the more frequent occurrence of this specific lung disease. Syndrome of bronchopulmonary disease in children with obstruction of the upper respiratory tract is characterized by the following symptoms: pallor, fatigue, persistent cough, anemia, subfebrile condition, weakened and hard breathing, dry wheezes, shortness of breath, regional and mediastinal adenopathy,

In rhinosinus bronchopulmonary diseases, bacteriological examination reveals only numerous saprophytic microorganisms, bronchoscopy - the presence of viscous mucus in the lumen of the bronchi, the study of ENT organs - certain phenomena of rhinosinusopathy and obstruction of the upper respiratory tract.