Feng shui taboo of nasal polyps
Etiology of nasal polyps
It is caused by long-term edema of nasal mucosa, which is the result of many factors, mainly allergic reaction and chronic inflammation.
At first, it is local mucosal edema, translucent protrusion and sessile, which is called polypoid degeneration at this time. The lesion continues to develop, and due to the seriousness of edema tissue, it gradually droops and forms pedicled polyps. Nasal polyps can be divided into edema type (mucus type), vascular type (bleeding type), fibrous type, cyst type, etc. The common types are edema type or mixed type.
Symptoms of nasal polyps
Mainly progressive nasal congestion, with the slow growth of polyps, it gradually becomes persistent nasal congestion. It is often accompanied by sinusitis, which increases nasal discharge. Symptoms such as olfactory dysfunction and headache may occur. It can be single or multiple, unilateral or bilateral, and most of them are multiple and bilateral. When the polyp grows too large, the external nose can be deformed, and the bridge of the nose widens and expands to form a "frog nose". A single polyp hanging in the posterior nostril is called a posterior nostril polyp. Complications are often accompanied by sinusitis, which increases nasal discharge.
The principle of treatment should be to relieve nasal congestion and prevent recurrence. According to the specific situation, the following treatment measures can be taken:
1. Medical treatment Because nasal polyps are the result of long-term inflammatory reaction of nasal mucosa and respiratory tract, corticosteroids can not only make polyps smaller or even disappear, but also delay or prevent the recurrence of postoperative polyps. There are two ways to administer glucocorticoids: systemic application is suitable for the following situations without contraindications: ① it is inconvenient to introduce instruments into the nasal cavity when polyps are large; ② The newly diagnosed patients are willing to receive medication, taking 30mg of prednisone orally every day for 7 days, and then decreasing 5mg every day. The whole course of treatment should not exceed two weeks. This short-term shock therapy will not cause obvious systemic side effects in clinic. Generally, the volume of polyps treated by the above methods can be significantly reduced, and some nasal congestion can be alleviated after a few days of oral administration, and the sense of smell can be significantly improved. At this time, it can be taken out surgically or changed to intranasal local application.
The advantage of topical application of corticosteroids in nasal cavity is that it can not only avoid the systemic side effects of corticosteroids, but also maintain the local effective concentration of drugs. Local application is suitable for: ① patients with small polyps and no more than the lower edge of middle turbinate at the time of initial diagnosis; ② Patients with better response after oral prednisone are willing to continue medical treatment; ③ Aerosol is the most common dosage form for intranasal application of adrenocortical hormone to prevent recurrence after surgical resection. In addition, nasal drops require patients to take the correct nasal position when using, but the preparation process of the drug is simple and the cost is low. The corticosteroids used in the nose are mainly dexamethasone dipropionate, flunisolone and budesonide, which are not easily absorbed into the blood by the nasal mucosa and produce the whole body. In recent years, Johansen( 1993) compared the efficacy of budesonide aerosol and nasal drops on nasal polyps. Results The curative effects of the two formulations were similar, and the author and others (1995) used 0. 1% triamcinolone acetonide nasal drops, which also achieved good results. The following conditions can obviously affect the curative effect of nasal medication: ① The nasal polyp is too big to enter the nasal cavity, so surgery should be performed first. Then intranasal administration is performed to prevent recurrence. ② Mixed infection of nose and sinuses exists at the same time. Antibiotic therapy or sinus cleaning should be performed at this time. ③ Polyp itself is in an active stage and grows too fast. At this time, corticosteroids can be suddenly applied to the whole body.
2. Surgical treatment will seriously affect the physiological function of most or all nasal cavities. Before the operation, the patient should undergo a general examination. For example, he suffers from cardiovascular disease and asthma attacks until his condition is stable. There are two main surgical methods: simple nasal polypectomy and intranasal ethmoidectomy.
1. Simple nasal polypectomy is used to remove pedicles. People who have no previous history of nasal polypectomy use nasal polyp traps under local anesthesia. After tightening the pedicle, pull it out of the nose and take out the polyp together with the pedicle. If there is a residual pedicle, clip it clean and pull out the polyp. Sometimes, the ethmoid sinus can be opened. At this time, if the mucosa in ethmoid sinus has become polypoid, intranasal ethmoidectomy should be performed at the same time.
2. Endoscopic sinus surgery in recent years provides an accurate and effective method for ethmoidectomy. By fully opening the ethmoid sinus mucosa and completely removing the polyps in the sinus, the recurrence rate of polyps can be significantly reduced.
In short, the treatment of nasal polyps should refer to the following principles:
1. For newly diagnosed patients, if polyps seriously affect nasal function, surgery should be performed first; Those with small polyps and light nasal congestion can be treated by internal medicine 1 month, and those with poor curative effect can be treated by reoperation.
2. Patients with sinus infection should undergo anti-infection or nasal polypectomy to open sinus drainage.
3. Nasal corticosteroid 65438+ should be given to nasal polyps that recur 0 ~ 2 years after ethmoidectomy.