Nasal foreign bodies (NFBs)
Doctors often have to meet with nasal foreign bodies, but there is no summarizing data on this issue. In the literature describes only a few cases (without the emphasis on physicians errors). Nasal foreign bodies occurs predominantly in young children, and therefore errors are more common in pediatric otorhinolaryngology.
Foreign bodies fall into the nasal cavity often through the right half. They need to look for especially in the inferior nasal passage, rarely — in middle, even less — in the superior part. Sometimes, negligently, after surgical procedures foreign bodies appear in the nasal cavity (pieces of cotton wool, swabs, pieces of surgical instruments).
Through the posterior nasal apertures (choanae) foreign bodies can get into the nasal cavity during vomiting (usually this happens if the soft palate paralysed and in various palate congenital anomalies). Foreign bodies can get into the nasal cavity by trauma (when violated the integrity of the walls of the nose), but even in children this way is extremely rare.
Ways of getting foreign bodies in nasal cavity:
- Introduced into the nasal cavity by the victim himself
- Introduced into the nasal cavity by foreign hand (during the game, medical manipulations)
- Accidentally got in the nasal cavity (through the nasal vestibule, through the choanae)
- Trapped in the nasal cavity with injury
Nasal foreign bodies may be a variety of items: coins, bits of cotton or paper, pencil lead, fruit seeds, beads, small parts from toys, etc.
To avoid confusion, it should be remembered, that in the nasal cavity can be teeth (incisors and canines), which grow there from the tooth germs as a result of inversion (heterotopia).
In the presence of a foreign body in the nasal cavity (usually it's a one-side process) observed difficulty in nasal breathing and purulent discharge from the corresponding half of the nose. Sharp foreign bodies can damage the mucous membrane that is accompanied by nasal bleeding. When finding a foreign body in the middle nasal passage observed loss of smell, watery eyes (due to blockage of the excretory duct of the lacrimal-nasal channel). Long stay of foreign body in the nasal cavity can lead to the development of inflammation of the paranasal sinuses, which will require adequate treatment.
In young children a reliable sign of nasal foreign body are unpleasant odor and purulent discharge from the affected half of the nose. In some cases the diagnosis is quite difficult, and can be erroneous, as in the nasal cavity develop granulation, which mask the presence of a foreign body. The feeling of the metal probe helps to avoid mistakes in the diagnosis of foreign bodies.
Contrast foreign bodies can be detected by radiography, computed tomography. When overgrown granulation in order to avoid errors it is necessary to differentiate them from malignant tumors of the nasal cavity.
The treatment consists in removing foreign body. In the past, doctors widely used sensitive non-instrumental methods of removal. The simplest of them — strong blowing the nose, but this method is applicable only in older children. For younger children performed blowing air into the mouth or through the free half of the nose in a manner Politzer.
The surest way to remove foreign body is instrumental, but it is most dangerous. Produce pre anemisation and anesthesia of the nasal mucosa. Round foreign bodies removed by a special probe with a curved end. Hook slid above and over the foreign body and remove by movement from back to front. Flat foreign bodies easier to remove nasal forceps. Wedged foreign bodies of large size must be pre-crushed and extracted in piecemeal. Inflammation caused by the presense of foreign body, after removing it quickly eliminated. However, prolonged pressure from foreign body on the bones develops osteomyelitis.
For the prevention of foreign bodies is necessary to exclude small objects from the everyday life of young children. Parents and older children need to explain the danger of ingress of foreign bodies in the nasal cavity. Special attention is necessary to prevent the occurrence of foreign bodies in operations on the nose, which, of course, is malpractice, followed by litigation.
Rhinoliths (nasal calculus)
Only some authors consider rhinoliths (nasal calculus) as foreign bodies. Rhinoliths (nasal calculus) is formed by salt deposits from the nasal mucous secretions and lacrimal glands around a long time presens foreign body in the nasal cavity.
The formation of rhinoliths facilitate changes in the nasal cavity (deviated septum, hypertrophy of turbinates) that cause the delay of the mucous secretions. Rhinoliths (nasal calculus) can be of various shapes: oval, round, plate. Sometimes they represent a cast of the nasal cavity. Rhinoliths are often single but may be plural, so to avoid errors you should carefully inspect the entire nasal cavity to the posterior nasal apertures (choanae).
Leading symptoms are unilateral nasal breathing difficulty, and purulent discharge from the corresponding half of the nose. Around rhinolith can thrive granulation. Sometimes there are general effects: headache, poor sleep. The differential diagnosis should be carried out with simple osteomas and foreign bodies.
Rhinolith treatment consists from its instrumental removing, large size rhinolith — surgically removing.
Live nasal foreign bodies
From the live nasal foreign bodies can meet worms (pinworms, ascarids, leeches), insect larvae. Ascarids fall into the upper respiratory tract from the digestive tract with vomiting or crawl there on their own. The children complain of headaches, discomfort in the nose. When the movement and manipulation of the ascarids can get into the sinuses, larynx, trachea and cause asphyxia, death. Ascarids of the nasal cavity is removed with tweezers.
Pinworms, trapped in the nasal cavity from the stomach, destroyed by menthol oil lubricating the mucous membrane of the nasal cavity, then remove it with tweezers.
By drinking water from stagnant water leeches can get into the nasopharynx and from it crawl into the nasal cavity, which is accompanied by bleeding, difficulty in nasal breathing, itching. Leech extract by grabbing with tweezers.
In addition, maggots can enter the nasal cavity, attach to the mucosa by using passivating apparatus and cause its destruction (as well as periosteum and underlying bone); during manipulations the special care is necessary (an opportunity of penetration into an orbit and a brain).
Children complain of headache in the frontal and parietal areas. Some have dizziness, which sometimes leads to diagnostic errors. From the nose there is abundant mucus with blood and an unpleasant smell (it is necessary to exclude a tumor). When the larvae move, irritation of the mucous membrane of the nasal cavity occurs, so children often sneeze, and this can lead to diagnostic errors.
Diagnosis is via the front rhinoscopy, in which the mucous membrane are determined by moving the white maggots. To clarify the diagnosis is necessary the use of optics. Then produce anemisation of nasal mucosa and recovered larvae nose by tweezers.
Nasal foreign bodies symptoms
Summarizing the above, note features of nasal foreign bodies. Sharp objects usually cause pain in the nose and bleeding. Foreign bodies that swell, make breathing difficult and lead to inflammation with purulent discharge. Small foreign bodies with a smooth surface can be asymptomatic for a long time, sometimes get into the nasopharynx, larynx, trachea and bronchi. If the foreign body lingers for a long time in the nose, it becomes the cause of a long rhinitis, the appearance of granulations. On the foreign body and around it are deposited inorganic salts (calcareous and phosphoric), making it look like a stone (rhinolith).
To date, the etiology of rhinoliths remains unclear. Apparently, the reason for their formation is not always the foreign body.
Nasal foreign bodies diagnosis
With unilateral nasal congestion, purulent or blood secretions with an unpleasant odor clarify the anamnesis, produce a rhinoscopy, palpation with a probe, etc. To reduce edema, apply a 0.1% solution of adrenaline. A small foreign body with swollen and bleeding mucosa, when it is surrounded by lush granulations or located in the back of the nasal cavity, is easier to find with the use of optics. Metallic foreign bodies and so-called lost teeth are diagnosed by the method of radiography and computed nasal tomography (CT).
Nasal foreign bodies treatment
Nasal foreign body sometimes moves spontaneously (when sneezing), but usually it is removed instrumentally. In this case, it is necessary to prevent the aspiration of the foreign body into the lower respiratory tract. A small foreign body removed blunt hook, which give birth to him. Removing the produce at the bottom of the nasal cavity in the direction from back to front. It is inappropriate (and in some cases, dangerous) to remove solid foreign body by forceps.
Do not try to remove the foreign body by blowing air ("Politzer's shower) or by pouring water into the intact nasal side. This requires such a high pressure, that it creates a danger of penetration of the discharge from the nose or irrigation fluid into the auditory (eustachian) tubes, resulting in develop purulent inflammation of the middle ear, and the foreign body will remain unremoved. Thus, the requirements, which is required for the removal of foreign body from external auditory canal, in this case incorrect. Do not try to remove the body of a rounded shape with a forceps or tweezers (the attempt will be unsuccessful, moreover, when the branches of the instrument are closed, the round foreign body is moving deeper).
Forceps-like tool removes only the buttons are flat and similar in shape objects (they can be installed in the nasal passage, like the wheels on the machine and compressed with forceps on both sides). The same applies to soft objects - swollen peas, seeds, cotton balls, etc. For the removal of round objects, it is preferable to use a so-called ear spoon or a thick buttoned probe, which is easy to impart a curved shape. With the help of this tool bypass over the object by directing bending spoons or recess behind the object and remove it by lifting up the hand is in the end of the probe or the tool and pushing the foreign body strong movement from back to front. In this case, it is necessary to hold the child tightly. Lubricating the nasal entrance with a 10% cocaine solution greatly facilitates the task, as, on the one hand, the defensive movements of the child are weakened, and on the other, the swollen anterior end of the inferior nasal concha is shed due to the vasoconstrictive action of cocaine.
If the first attempt fails or if the foreign body is large, is deep in the nasal cavity or upper in the middle nasal passage, if it is poorly visible and achievable, the child should not be tormented by extraction. It causes him pain, causes bleeding and greatly complicates the removal of another, experienced professionals who intervene in this situation it is necessary.
In the case of a successful attempt to free the nasal patency is restored, enhanced and modified mucus discharging, swelling and cracks disappear after a few hours or days, without requiring further treatment.
Kwa kawaida, madaktari hupata maambukizi ya mwili wa kigeni wa pua, lakini hakuna data ya jumla juu ya suala hili. Katika fasihi inaelezea tu kesi chache (bila msisitizo juu ya makosa madaktari). Miili ya kigeni ya pua hutokea hasa kwa watoto wadogo, na kwa hiyo makosa ni ya kawaida zaidi katika otorhinolaryngology ya watoto. Mara nyingi viumbe wa kigeni huingia ndani ya pua kupitia sehemu ya kulia. Wanahitaji kuangalia hasa katika njia ya chini ya pua, mara chache <unk> katikati, hata chini <unk> katika sehemu ya juu. Wakati mwingine, kwa uzembe, baada ya upasuaji, viumbe wa kigeni huonekana katika shimo la pua (vipande vya sufu ya pamba, swabs, vipande vya vyombo vya upasuaji). Kupitia upasuaji wa nyuma wa pua (choanae) miili ya kigeni inaweza kuingia ndani ya shimo la pua wakati wa kutapika (kwa kawaida hii hutokea ikiwa palate laini imepooza na katika kasoro mbalimbali za kuzaliwa za palate). Mwili wa kigeni unaweza kuingia ndani ya pua kwa sababu ya majeraha (wakati wa kuvunjwa kwa ukuta wa pua), lakini hata kwa watoto njia hii ni nadra sana. Mwili wa kigeni unaweza kuingizwa ndani ya pua kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi, kwa njia ya pua ya mtu binafsi. Ili kuepuka kuchanganyikiwa, ni lazima kukumbukwa kwamba katika shimo la pua inaweza kuwa meno (incisors na canines), ambayo kukua huko kutoka vijidudu meno kama matokeo ya inversion (heterotopia). Kwa kuwapo kwa mwili wa kigeni katika shimo la pua (kwa kawaida ni mchakato wa upande mmoja) hutambuliwa ugumu katika kupumua pua na kutolewa kwa purulent kutoka nusu inayolingana ya pua. Viumbe wa kigeni wenye makali wanaweza kuharibu utando wa utando ambao huambatana na kutokwa na damu kutoka pua. Wakati wa kupata mwili wa kigeni katika njia ya katikati ya pua, upotezaji wa harufu, macho ya maji (kwa sababu ya kuziba kwa njia ya kutolea nje ya mfereji wa machozi ya pua). Kukaa kwa muda mrefu kwa mwili wa kigeni katika shimo la pua kunaweza kusababisha ukuaji wa uvimbe wa sinuses paranasal, ambayo itahitaji matibabu ya kutosha. Katika watoto wadogo, ishara ya uhakika ya mwili wa kigeni wa pua ni harufu mbaya na mtiririko wenye umajimaji kutoka nusu iliyoathiriwa ya pua. Katika baadhi ya kesi, utambuzi ni vigumu sana, na inaweza kuwa na makosa, kama katika shimo la pua kuendeleza granulation, ambayo mask uwepo wa mwili wa kigeni. Hisia ya chombo cha chuma husaidia kuepuka makosa katika utambuzi wa miili ya kigeni. Vitu vya kigeni vinavyofanana vinaweza kugunduliwa kwa kutumia uchunguzi wa radiografia, uchunguzi wa kompyuta. Wakati overgrown granulation ili kuepuka makosa ni muhimu kutofautisha yao kutoka uvimbe mbaya ya shimo la pua. Matibabu hayo yanahusisha kuondoa mwili wa kigeni. Zamani, madaktari walitumia sana mbinu nyeti zisizo za kitiba za kuondoa. Njia rahisi zaidi ni kupiga pua kwa nguvu, lakini mbinu hiyo inaweza kutumiwa tu kwa watoto wakubwa. Kwa watoto wadogo, pumzi ya hewa hufanywa kupitia mdomo au nusu ya pua iliyo huru kwa njia ya polizer. Njia ya hakika zaidi ya kuondoa mwili wa kigeni ni ya kutumia kifaa, lakini ni hatari zaidi. Kuzalisha preanemisation na anesthesia ya mucosa ya pua. Miili ya kigeni ya mviringo iliyoondolewa kwa chombo maalum chenye ncha iliyojipinda. Hook slide juu na juu ya mwili wa kigeni na kuondoa kwa harakati kutoka nyuma kwa mbele. Ni rahisi kuondoa viungo vya kigeni vilivyo tambarare kwa kutumia forceps za pua. Wedged miili ya kigeni ya ukubwa mkubwa lazima pre-crushed na kuchukuliwa katika kipande. Uvimbe unasababishwa na uwepo wa mwili wa kigeni, baada ya kuondolewa ni haraka kuondolewa. Hata hivyo, shinikizo la muda mrefu kutoka kwa mwili wa kigeni kwenye mifupa hufanyiza osteomyelitis. Kwa ajili ya kuzuia miili ya kigeni ni muhimu kuondoa vitu vidogo kutoka maisha ya kila siku ya watoto wadogo. Wazazi na watoto wakubwa wanahitaji kueleza hatari ya kuingia kwa vitu vya kigeni katika shimo la pua. Ni muhimu kuepuka kuonekana kwa miili ya kigeni katika upasuaji wa pua, ambayo ni kosa la matibabu na kusababisha kesi. Rhinoliths (nasal calculus) Ni waandishi fulani tu wanaochukulia rhinoliths (nasal calculus) kuwa miili ya kigeni. Rhinoliths (mchanga wa pua) hufanyizwa na amana za chumvi kutoka kwa secretions za mucous za pua na tear glands karibu na muda mrefu huonyesha mwili wa kigeni katika shimo la pua. Kuundwa kwa rhinoliths kuwezesha mabadiliko katika shimo la pua (deviated septum, hypertrophy ya turbinates) ambayo husababisha kuchelewesha kwa secretions mucous. Rhinoliths (nasal calculus) inaweza kuwa na maumbo mbalimbali: oval, mviringo, sahani. Nyakati nyingine huwakilisha mchoro wa shimo la pua. Rhinoliths ni mara nyingi moja lakini inaweza kuwa nyingi, hivyo ili kuepuka makosa unapaswa makini kuchunguza cavity nzima ya pua kwa apertures nyuma ya pua (choanae). Dalili kuu ni ugumu wa kupumua kupitia pua kwa upande mmoja, na kutokwa kwa umajimaji kutoka nusu inayolingana ya pua. Karibu na rhinolith kunaweza kuwa na chembechembe. Nyakati nyingine kuna athari za jumla: maumivu ya kichwa, usingizi mbaya. Uchunguzi wa tofauti unapaswa kufanywa na osteomas rahisi na miili ya kigeni. matibabu Rhinolith inajumuisha yake instrumental kuondoa, ukubwa mkubwa rhinolith <unk> upasuaji kuondoa. Mwili wa kigeni wa pua unaoishi Kutoka kwa miili ya kigeni ya pua inayoishi inaweza kukutana na minyoo (pinworms, ascarids, leeches), mabuu ya wadudu. Ascarids huanguka katika njia ya juu ya kupumua kutoka kwa mfumo wa kumeng'enya chakula kwa kutapika au kutambaa huko peke yao. Watoto wanalalamika juu ya maumivu ya kichwa, usumbufu katika pua. Mzunguko wa ascarids unaweza kuathiri sinus, larynx, trachea na kusababisha asphyxia. Ascarids ya shimo la pua huondolewa kwa tweezers. Worms, zilizokamatwa katika pua kutoka tumbo, kuharibiwa na mafuta ya menthol lubricating utando wa pua, kisha kuondoa kwa tweezers. Kwa kunywa maji kutoka kwa maji yaliyokwama, leeches zinaweza kuingia katika nasopharynx na kutoka kwake kuingia katika shimo la pua, ambalo linaambatana na kutokwa na damu, ugumu wa kupumua kwa pua, kukwaruza. Kuondoa leech kwa kukamata kwa tweezers. Nyigu wanaweza kuingia katika pua, kuunganisha na mucosa kwa kutumia vifaa vya passivation na kusababisha uharibifu wake (kama vile periosteum na mifupa ya chini); wakati wa udhibiti, tahadhari maalum ni muhimu (uwezekano wa kupenya katika mzunguko na ubongo). Watoto hulalamika juu ya maumivu ya kichwa katika sehemu za mbele na za chini. Wengine huwa na kizunguzungu, ambacho nyakati nyingine husababisha makosa ya utambuzi. Kutoka pua kuna umajimaji mwingi wenye damu na harufu mbaya (ni lazima kuondoa uvimbe). Wakati larvae kusonga, irritation ya utando wa utando wa pua hutokea, hivyo watoto mara nyingi sneeze, na hii inaweza kusababisha makosa ya utambuzi. Uchunguzi wa ugonjwa huo hufanywa kwa kutumia uchunguzi wa pua ya mbele, ambapo utando wa utando huamuliwa kwa kuhamisha minyoo nyeupe. Ili kufafanua utambuzi ni muhimu matumizi ya optics. Kisha kuzalisha anemization ya mucosa pua na kurejeshwa larva pua na tweezers. Dalili za miili ya kigeni ya pua Kwa muhtasari wa yaliyotajwa hapo juu, angalia sifa za miili ya kigeni ya pua. Vitu vyenye makali kwa kawaida husababisha maumivu ya pua na kutokwa na damu. Miili ya kigeni inayovimba, hufanya upumuaji uwe mgumu na kusababisha uvimbe na kutokwa kwa umajimaji. Mwili mdogo wa kigeni wenye uso laini unaweza kuwa asymptomatic kwa muda mrefu, wakati mwingine kupata katika nasopharynx, larynx, trachea na bronchi. Ikiwa mwili wa kigeni unabaki kwa muda mrefu katika pua, inakuwa sababu ya rhinitis ndefu, kuonekana kwa granulations. Kwenye mwili wa kigeni na kuzunguka kwake kuna chumvi zisizo za kikaboni (kalkari na fosforasi), zikifanya ionekane kama jiwe (rhinolith). Hadi sasa, chanzo cha ugonjwa huo hakijulikani wazi. Yaonekana, si kila wakati mwili wa kigeni ndio husababisha kuumbwa kwao. Ugonjwa wa mwili wa kigeni wa pua: Kwa congestion ya pua ya upande mmoja, purulent au damu secretions na harufu mbaya kufafanua anamnesis, kuzalisha rhinoscopy, palpation na probe, nk. Ili kupunguza uvimbe, tumia suluhisho la 0.1% la adrenaline. Mwili mdogo wa kigeni na mucosa iliyofurika na kutokwa na damu, wakati umezungukwa na granulations ya kijani au iko nyuma ya shimo la pua, ni rahisi kupata kwa kutumia optics. Vitu vya kigeni vya chuma na meno yaliyopotea huchunguzwa kwa njia ya radiografia na computed nasal tomography (CT). Matibabu ya mwili wa kigeni wa pua Mwili wa kigeni wa pua wakati mwingine husonga kwa hiari (wakati wa kupiga chafya), lakini kwa kawaida huondolewa kwa njia ya kifaa. Katika hali hii, ni muhimu kuzuia aspiration ya mwili wa kigeni katika njia ya chini ya kupumua. Mwili mdogo wa kigeni uliondolewa kwenye ndoano, ambayo ilimzaa. Kuondoa bidhaa katika sehemu ya chini ya shimo la pua katika mwelekeo kutoka nyuma hadi mbele. Si jambo la kufaa (na katika visa fulani, ni hatari) kuondoa mwili mgumu wa kigeni kwa kutumia forceps. Usijaribu kuondoa mwili wa kigeni kwa kupumua hewa ("mvua ya Politzer") au kwa kumimina maji katika upande wa pua usioharibiwa. Hii inahitaji shinikizo kubwa sana, ambayo huunda hatari ya kupenya kwa kutokwa kutoka pua au umajimaji wa umajimaji ndani ya mabomba ya kusikia (eustachian), na kusababisha kuendeleza uvimbe wa purulent wa sikio la kati, na mwili wa kigeni utabaki. Hivyo, mahitaji, ambayo inahitajika kwa ajili ya kuondolewa kwa mwili wa kigeni kutoka mfereji wa nje ya kusikia, katika kesi hii si sahihi. Usijaribu kuondoa mwili wa umbo la mviringo kwa forceps au tweezers (jaribio hilo halitafanikiwa, zaidi ya hayo, wakati matawi ya chombo yanafungwa, mwili wa kigeni wa mviringo unahamia kina). Vifaa vya kuondoa tu vifungo ni gorofa na sawa katika umbo la vitu ( vinaweza kuwekwa katika njia ya pua, kama magurudumu kwenye mashine na kufyatua na foresipsi pande zote mbili). Jambo hilohilo hutumika kwa vitu laini - maharagwe yaliyofurika, mbegu, mipira ya pamba, na kadhalika. Kwa kuondoa vitu vya mviringo, ni bora kutumia kile kinachoitwa kijiko cha sikio au probe nzito ya kifungo, ambayo ni rahisi kutoa umbo la mviringo. Kwa msaada wa chombo hiki, piga juu ya kitu kwa kuelekeza vijiko vya kugeuza au recess nyuma ya kitu na kuiondoa kwa kuinua mkono wako kwenye mwisho wa probe au chombo na kushinikiza mwili wa kigeni kwa harakati kali kutoka nyuma hadi mbele. Katika hali hiyo, ni lazima mtoto amshike kwa nguvu. Kupaka mafuta kwenye mlango wa pua kwa suluhisho la 10% la cocaine husaidia sana kazi, kwani, kwa upande mmoja, harakati za kujilinda za mtoto hupungua, na kwa upande mwingine, mwisho wa mbele uliofurika wa concha ya chini ya pua hutolewa kwa sababu ya athari ya vasoconstrictive ya cocaine. Ikiwa jaribio la kwanza linashindwa au mwili wa kigeni ni mkubwa, uko ndani ya shimo la pua au juu ya njia ya pua ya kati, ikiwa haionekani vizuri na haiwezi kufikiwa, mtoto haipaswi kuteswa kwa uchimbaji. Hii inaweza kusababisha maumivu, kutokwa na damu na kufanya iwe vigumu kwa wataalamu wenye uzoefu kuingilia hali hii. Katika kesi ya jaribio la mafanikio la kuondoa, upungufu wa pua unarudishwa, kuongezeka na kubadilishwa kwa kutolewa kwa mucus, uvimbe na nyufa hutoweka baada ya masaa machache au siku, bila kuhitaji matibabu zaidi.