Nasal discharge

Introduction Nasal discharge is one of the common symptoms of nasal diseases, which can flow out through the anterior nares or back to the nasopharynx. After the person's nostrils, the person who vomited through the nasopharynx and the mouth called the nasal discharge. In the normal nasal cavity, there is only a small amount of mucus, which is in a wet state to maintain normal physiological functions. Changes in the nature and amount of nasal secretions can occur when there is a lesion in the nasal cavity. When the nasal secretions overflow, it is called nasal discharge.

Cause

Under normal conditions, secretions from the nasal mucosa (including serous glands, mucous glands, serous mucous glands, goblet cells, and olfactory glands) have the function of a viscose ciliary system, regulate the temperature and humidity of the inhaled air, and maintain The role of normal olfactory function. The warming and humidification of the nasal cavity requires a lot of water. The normal mucociliary function needs to update the nasal mucus blanket 2-3 times per hour, requiring a lot of water. Normal people can discharge water from the nasal secretions up to 500-1000 m I per day, part of the water evaporates with the respiratory airflow, and the other part is sent to the nasopharynx by the ciliary movement, ingesting or squeezing out. These waters are mainly derived from the numerous microvilli of cells on the surface of the nasal mucosa, followed by the secretion of a large number of goblet cells and various glands in the mucosal epithelium. When there is a lesion, the amount and nature of the secretion change, according to its nature can be divided into aqueous, serous, mucinous, purulent, bloody.

(a) nasal foreign body

(two) nose stone

(three) nasal cavity teeth

(four) nasal inflammation

1. Acute rhinitis.

2. Chronic rhinitis.

(1) Simpleness.

(2) Hypertrophy.

3. Cheese rhinitis.

4. Vascular motor rhinitis.

5. Allergic rhinitis.

6. Eosinophilia allergic rhinitis.

(5) necrotizing granuloma

(6) sinusitis

1. Acute sinusitis.

2. Chronic sinusitis.

(7) Nasal fungal disease

(8) Nasal sinus tumor

1. Papilloma.

2. Maxillary sinus cancer.

(9) Cerebrospinal fluid rhinorrhea

an examination

Related inspection

Ear, nose, throat swab bacterial culture nasal endoscopy otolaryngography CT examination white blood cell antigen (HLA) challenge test

Judgment should be based on the nature of the nasal discharge, color, odor, mixed characters, and inspection findings.

(1) Nature, color, smell, mixed matter

1. Water-based: The secretion is thin, transparent like clear water, which is a mixture of vascular exudate and mucus, containing epithelial cells, white blood cells, a small amount of red blood cells and mucin. Found in the early stages of vasomotor rhinitis, allergic rhinitis and acute rhinitis.

2. Mucinous: The secretion is thick, transparent like water, containing a lot of mucin. When a normal person's nasal cavity is stimulated by cold or emotional impulses, a large amount of mucus can be secreted by reflection. Common in chronic simple rhinitis.

3. Mucus purulent: a mixture of mucus and pus. Found in the recovery period of acute rhinitis, chronic sinusitis.

4. Purulent: more common in inflammation and invasion of bone, such as osteomyelitis of the jaw, odontogenic maxillary sinusitis, nasal foreign body and partial necrosis of malignant tumor, all accompanied by different degrees of foul odor, fecal odor and other yellow-green secretions. Caseous rhinitis and sinusitis often excrete okara-like substances and have an odor.

5. Bloody: The secretions with blood or bloody secretions can be found in nasal foreign bodies, nasal stones, fungal sinusitis, and early symptoms of nasal malignant tumors.

6. Cerebrospinal fluid rhinorrhea.

(2) Inspection

1. General examination of the nasal cavity: pay attention to nasal mucosa color, turbinate, nasal passage, olfactory groove and so on. In acute rhinitis, the membrane is acutely congested with edema, and the nasal passages have clear watery, mucous, and purulent secretions. Chronic rhinitis, mucous membrane dark red, swollen, sticky in the nasal passages. Allergic rhinitis, vasomotor rhinitis, nasal mucosa pale purple gray. Acute and chronic sinusitis, pus in the middle nasal passage and olfactory sulcus. X-ray filming helps diagnose.

2. Endoscopic examination of the nose and sinuses: routine examination of the nasal or posterior nasal cavity of the nasal cavity has a limited range of examination of the nasal cavity. Many important parts of the nose, such as the opening of each sinus, are located in a narrow, concealed ditch or fossa that cannot be directly viewed, which makes it difficult to judge and diagnose the disease. Endoscopy of the nose and sinuses, in addition to the ethmoid sinus, all other sinuses can be used to look directly at the sinus. The source of purulent secretions can be clarified, and the pupil location of cerebrospinal fluid rhinorrhea can also be diagnosed.

3. CT examination: The application of CT has expanded the application of common X-ray and body layer examination for sinus diseases. Multiple trajectory layers and CT can be found in sinus lesions that x-ray films sometimes fail to display. CT can examine both the sinus and the brain, so it is an important method for the diagnosis of fatal sinus diseases.

To identify early benign and malignant lesions, CT can be used to distinguish vascular, fat, necrotic, hemorrhagic, cystic or calcified lesions, which is conducive to the analysis of the cause.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Runny nose: Runny nose is one of the common symptoms of nasal diseases. It can flow out through the anterior nares or into the nasopharynx. After flowing into the nostrils, the nasopharynx and the oral cavity are said to have a runny nose. There is only a small amount of mucus in the normal nasal cavity, which is in a wet state to maintain normal physiological functions. Changes in the nature and amount of nasal secretions can occur when there is a lesion in the nasal cavity. When the nasal secretions overflow, it is called a runny nose.

2. Nostril pus: is a mucosal pathological change characterized by edema, thickening, vascular hyperplasia, lymphatic thoracic and plasma cell infiltration, epithelial cilia shedding or squamous metaplasia and polypoid changes, if the secretion gland is blocked, then A cystic change occurs.

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