Swelling of the nasal mucosa

Introduction Swelling of the nasal mucosa is more common in rhinitis. From the pathological changes of the nasal mucosa, there are chronic simple rhinitis, chronic hypertrophic rhinitis, cheese rhinitis, atrophic rhinitis, etc.; from the onset of the disease and the length of the disease, can be divided into acute rhinitis and chronic rhinitis . In addition, there are some rhinitis, although the onset is slow, the course of disease continues for a long time, but there are specific causes of the disease, so there are specific names, such as allergic rhinitis (ie allergic rhinitis), drug rhinitis.

Cause

The stability of the nasal mucosa environment, in addition to relying on neuromodulation, also accepts the regulation of endocrine hormones. The nasal mucosa is rich in various components of the vascular bed and mucosal immunity. At the level of the neuroendocrine immune network, changes in the levels of endocrine hormones can affect the nasal mucosa through blood circulation. In patients with clinically common female rhinitis, the symptoms are significantly aggravated in the premenstrual period, and the symptoms are alleviated or disappeared after the menstrual period. Menstrual and gestational women have hypertrophy of the nasal mucosa and dilated glands.

The result of the above changes can produce respiratory mucosal immune or non-immune inflammation leading to the formation of high reactivity of the nasal mucosa, thereby causing rhinitis symptoms such as nasal congestion, runny nose, itchy nose, and sneezing. In addition, prostaglandins can inhibit the production of antibodies by B cells and inhibit the phagocytic function of macrophages. At the same time, prostaglandins as an inflammatory factor can cause vasodilatation in the onset of rhinitis and aggravate the degree of inflammatory response. In the nasal mucosa of patients with allergic rhinitis, the prostaglandin receptors also increase, resulting in dilated blood vessels in the nasal mucosa, nasal congestion and corresponding nasal congestion and hypersensitivity.

an examination

Related inspection

Nasal endoscopy nasopharynx MRI

Basic inspection:

1. Front nose examination.

2. X-ray films clearly have no sinus infection.

Further examination:

1. Nasal secretion smear to detect pathogenic bacteria.

2. Nasal secretions bacterial culture + drug sensitivity.

3. If necessary, virus inspection requires special cultivation, separation and identification.

Differential diagnosis

The symptoms of swelling of the nasal mucosa need to be identified as follows.

1, acute rhinitis: caused by acute infection, commonly known as "cold" or "cold", may have systemic symptoms; more common in autumn and winter or winter and spring. The condition usually improves after 7 to 14 days. Those with strong resistance can heal themselves. Common nasal mucosa is an acute inflammation that is a viral infection and often secondary to bacterial infections. The main symptoms are nasal blockage and increased secretions. In the early stage, it is a clear watery sputum, and then becomes a mucopurulent nasal discharge. The patient may have low fever and general malaise. Check the nasal mucosa congestion and swelling, there are secretions. The disease should be based on prevention. After taking the disease, take the heat-clearing and detoxifying drugs, drip 1% ephedrine solution in the nose, and take sulfa drugs or antibiotics if necessary.

2, chronic rhinitis: is a common and frequently-occurring disease, developed from acute rhinitis. It is associated with secondary bacterial infection, incomplete treatment and recurrent episodes. It is a chronic inflammation of the nasal mucosa and submucosa. Very common, mild is called simple chronic rhinitis, and severe is called hypertrophic rhinitis. The main symptoms are nasal obstruction, the light is intermittent or alternating, the severe is persistent, and the nasal secretions increase. Check the nasal mucosa congestion and swelling, a small amount of mucous secretions in the nasal passages, severe hypertrophic rhinitis due to tissue hyperplasia, mucosal surface uneven, lower inferior turbinate mulberry-like changes, middle turbinate mucosa showed polypoid changes. Intranasal instillation of vasoconstrictors, such as 1% ephedrine, can improve nasal ventilation and drainage, causing inflammation to subside. Heavier patients can be injected subcutaneously into the inferior turbinate submucosa, or can be used for electrocautery or cryotherapy to improve ventilation. In severe cases, the proliferative part of the turbinate should be surgically removed. Chinese medicine and acupuncture treatment have certain effects on mild patients.

3. Allergic rhinitis: It is caused by the nasal mucosa being highly sensitive to certain components in the inhaled air. Its symptoms are very similar to those of a cold, but it can occur multiple times in a day; when it does not, it is completely normal. The onset of allergic rhinitis is sometimes closely related to the season.

4, chronic hypertrophic rhinitis: from chronic simple rhinitis, is a long-term chronic inflammation, congestion and caused by the proliferation of nasal mucosa, turbinate. At this time, the mucosa is thickened, the tissue elasticity is lowered, and the nasal cavity ventilation ability is poor, thereby jeopardizing the physiological function of the nose.

5. Dry rhinitis: The occurrence of dry rhinitis is closely related to climate and occupational factors. The nasal mucosa is stimulated for a long time, and the mucous gland is atrophied and the secretion is reduced. The mucous membrane is thus dry and even superficial erosion.

6, atrophic rhinitis: mainly nasal mucosa, periosteum and turbinate bone atrophy; due to atrophy of the nasal tissue, although the nasal cavity is relatively large, but the nasal mucosa lost its normal physiological function, and due to the formation of intranasal dryness, the patient still feels ventilated Not smooth. When there is a bacterial infection, its toxins and excretions produce a foul odor. Both primary and secondary. The cause of the primary disease is unknown, there is nasal mucosa and bone atrophy. The patient has a stuffy nose, an odor in the nose, and purulent sputum. Check the nasal mucosa dry atrophy, the lower turbinate shrinks to cause the nasal cavity is wide, due to bacterial infection, the nose has a lot of gray-green stained skin, smelly, it is also called stinky nose. Severe cases can be followed by atrophic pharyngitis and laryngitis. There is no specific treatment for this disease. Rinse the nasal cavity with normal saline to remove the molting, drip liquid paraffin, compound peppermint oil, compound cod liver oil mixture, etc. to alleviate the symptoms. Children orally or intramuscularly inject vitamin A. Surgical treatment such as narrowing the nose has been used to treat this disease, and its effect is limited. Secondary patients include excessive removal of the turbinate during surgery, radiation therapy of nasal, sinus and nasopharyngeal malignancies, long-term exposure to irritating dust or chemical gases.

7, cheese rhinitis: is a rare nasal disease. The clinical feature is the accumulation of intranasal cheese-like substances, which has a foul odor, which erodes soft tissues and bones over a long period of time, and deforms intranasally and externally. Exfoliated epithelium, necrotic tissue, suppurative cells, cholesterol crystals, and mold-like microorganisms were found in the cheese-like substance.

8, drug rhinitis: drug rhinitis is the result of long-term continuous use of inappropriate nasal medication, can also be understood as a chronic rhinitis. The cause of the disease is inappropriate nasal medication, including the use of a strong nasal mucosa vasoconstrictor nasal drops, high concentration of liquid medicine, non-isotonic liquid, overdose or long-term medication. These can damage the structure of the nasal mucociliary, thereby affecting the physiological function of the nasal mucosa and producing clinical symptoms.

9, allergic rhinitis: commonly known as allergic rhinitis, the main symptoms are sudden itchy nose, sneezing, runny nose, nasal congestion, and repeated attacks. People who are ill all year round are called perennial allergic rhinitis, and the authors call seasonal allergic rhinitis only during the fixed season. The former is mainly caused by dust, mites, molds and cotton wadding in the house, and the latter is mainly caused by pollen. The disease is a type I allergic disease. It is characterized by rapid and sudden onset of symptoms, so it is also called instant hairstyle. When an allergic person comes into contact with an allergic substance, immunoglobulin E (IgE) is produced in the body. After IgE is formed, it adsorbs on the surface of basophils and sensitizes the body. When the same allergen is contacted again, the substance binds to IgE, activates the enzyme in the basophil, releases a medium such as histamine or slow-reacting substance, acts on certain tissues, and causes a series of symptoms. When allergic rhinitis occurs, the nasal mucosa is pale and edematous, and a large amount of nasal discharge remains in the nose. Hay fever is related to the bleaching period of some pollen. In northern China, it occurs more than July to September, mainly to Artemisia. In addition to nasal symptoms, there may be eye, ear, pharynx and itchy skin or asthma. Perennial people need to undergo laboratory tests to distinguish them from chronic rhinitis. This type of patient is often mistaken for a cold, acute rhinitis.

Allergic rhinitis can be desensitized treatment and anti-allergic drugs, such as chlorpheniramine, ketotifen, sinmin, sinimin and nasal sedative; intranasal drip vasoconstrictor drugs to improve nasal congestion and runny nose; Surgical treatment may also be considered when necessary. The nose is turbid and turbid, and the amount is more than a few. It is accompanied by headache, nasal congestion, and decreased sense of smell. It is equivalent to sinusitis in Western medicine.

10, seasonal rhinitis: also known as "hay fever", its incidence has obvious seasonality, spring and autumn are high season. The nose has a poor adaptability to this cold and hot climate change, and it is easy to induce seasonal rhinitis without adapting to cold air. Seasonal allergic rhinitis can be prevented not by keeping warm, but also to strengthen the nose's ability to adapt to cold air. In autumn and winter, washing your nose with cold water can improve your nose's ability to adapt to cold air. On the contrary, people who wash their faces with warm water or hot water are more likely to induce seasonal rhinitis in the cold weather.

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