caseous rhinitis
Introduction
Introduction to cheese rhinitis Caseous rhinitis and sinusitis are cheese-like masses that accumulate in the nasal cavity or sinus. They invade the surrounding tissues and bones in a long time. In severe cases, nasal deformities can occur. It is rare in clinical practice. In the past, this disease was called nasal cholesteatoma, but it lacked histological basis. In recent years, most scholars believe that this disease is due to chronic suppurative inflammation of the nasal cavity or sinus, nasal obstruction, poor drainage of secretions, and then cheese-like necrosis and purulent secretions in the mucosa, eventually forming a cheese-like substance accumulated in the nasal cavity or sinus. To. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: nosebleeds, headaches
Cause
The cause of cheese rhinitis
Special infection (15%):
In 1868, Duplay proposed the theory of rhinorrhea due to two cases of nasal erysipelas complicated with caseous rhinitis, but there was no similar report. In 1889, Cozzollion found a tuberculosis-like bacterium in the cheese substance, which is thought to be linked to tuberculosis. Of the 35 cases with complete domestic data, only 1 case was associated with tuberculosis, and other cases were normal in the lungs. Therefore, the doctrine is based on insufficient. Some scholars believe that caseous rhinitis is caused by the formation of syphilis, and 16 of the 35 cases in China have blood Kang Kang reaction, only 2 cases are strongly positive, 2 cases are weakly positive, and other cases are negative, and pathological examination There has also been no evidence of a change in syphilis.
Nasal cholesteatoma (25%):
In 1889, Tillaux et al. proposed this theory, suggesting that caseous rhinitis is similar to cholesteatoma in the ear, but in 1900 Kelson's examination of the nasal mucosa and secretions of caseous rhinitis confirmed that the majority of patients with nasal mucosa remained columnar epithelium. Or breathe the epithelium. There were 23 cases of nasal mucosal pathology in China, most of which were inflammatory changes. Only 3 cases of nasal mucosa columnar epithelium showed squamous cell or squamous metaplasia. Therefore, the establishment of this doctrine still requires further observation and research.
Nasal polyps degeneration and necrosis (20%):
Sheicher et al. found that necrotic necrotic tissue was found in nasal cheese or in a necrotic necrotic nasal polyp, and that degeneration and necrosis of nasal polyps could form a cheese-like substance. Polson recalled that none of the previous cases had nasal polyps. Of the 35 cases in China, 12 had polyps or necrotic polypoids in the nasal cavity. Therefore, the theory is worthy of discussion. Nasal polyps obstruction and degeneration and necrosis may play a role in the pathogenesis of this disease, but in patients with a history of nasal polyps in the clinic, there is no cheese rhinitis, so consider the disease in addition to obstruction factors. In addition, there must be other more important pathogenic mechanisms.
Trauma factor (10%):
Some scholars have found that many cases of caseous rhinitis and sinusitis are caused by trauma, bullet wounds on the cheeks, nasal sinus surgery may cause epidermal fragments to fall into the sinus or damage to the nerve endings in the sinuses due to trauma, and nutritional disorders occur, leading to nasal cavity. The inner columnar epithelium is denatured and becomes a stratified squamous epithelial cell, which causes osteonecrosis of the sinus wall. None of the domestic cases were caused by trauma.
Suppurative inflammation and obstruction of the nose (20%):
Most scholars accept this theory and believe that caseous rhinitis is due to mechanical obstruction in the nasal cavity. It can be foreign body, abnormal nasal structure (such as nasal septum deviation, turbinate hypertrophy, etc.) and new organisms, resulting in poor drainage and accumulation of secretions. Combined with chronic suppurative inflammation, the nasal mucosal necrosis and purulent secretions are concentrated, and the pus cells are fatty degenerated, eventually forming a solid soft cheese-like substance.
Prevention
Cheese rhinitis prevention
1. No matter whether you are sick or not, keep your nose clean and pay attention to hygiene.
2, do not arbitrarily dig the nose, do not pull the nose hair.
3, work or living environment, and strive to fresh air, pay attention to prevent pollution.
4, eat all smoke, alcohol, spicy and irritating food.
5, otolaryngology medical staff, should pay attention to the strict disinfection of medical equipment to prevent cross-infection.
6. Corrupted dirt that has been removed and burned. If it cannot be burned, it should be strictly disinfected.
Complication
Caseous rhinitis complications Complications, nosebleeds, headache
A small amount of nosebleeds, olfactory hypoactivity and dizziness, headache, loss of appetite, etc., such as invading the sphenoid sinus, can impair vision and cranial nerve palsy.
Symptom
Case of cheese rhinitis Common symptoms Osteoporosis White sputum nose, nose, nose, nose, nose, dead bone, eyeball, nose, smelly nasal mucosa and turbinate atrophy, nasal septum, perforation, nasal drying
The cheese sample is a semi-solid yellowish unstructured structure composed of pus cells, necrotic tissue, exfoliated epithelium, stearin, a small amount of amorphous crystals such as cholesterol and calcium salt; among them, fungi such as white streptococci can be found. Microorganisms such as diphtheria bacilli can occasionally see foreign bodies, nose stones or dead bones. The pathological changes of the nasal mucosa vary depending on the severity of the disease. Inflammatory infiltration, hyperplasia, and mucosal degeneration and necrosis occur in severe cases. And granulation, and even more bone destruction, external nose deformation or fistula formation.
More than one side of the disease, the course of the disease is slow, the main symptoms are progressive nasal obstruction, purulent nasal odor, a small amount of nosebleeds, decreased sense of smell and dizziness, headache, loss of appetite, etc., such as invasion of the sphenoid sinus, can damage vision and brain Nerve paralysis.
Examine
Examination of cheese rhinitis
an examination
In the nasal cavity, the cheese sample accumulated, the nasal septum was perforated, the external nose was deformed, the eyeball was displaced, and the anterior wall of the maxillary sinus or the hard palate was seen. The sinus was uniformly blurred in the early X-ray film, and the sinus cavity enlargement and bone destruction were observed in the late stage. Only chronic inflammation is shown and must be differentiated from malignant tumors.
Biopsy: referred to as "biopsy". Biopsy is to cut a part of the diseased tissue from the suspicious part of the body with a lesion for pathological biopsy to confirm the diagnosis. This method is accurate and reliable, and can provide timely diagnostic advice for reference during treatment. It is a commonly used diagnostic method in clinical practice.
Diagnosis
Diagnosis and identification of caseous rhinitis
According to the unilateral progressive nasal obstruction with a history of odor and purulent sputum, nasal examination found a large number of bean dregs, can be diagnosed, if necessary, imaging examination.
The disease should be differentiated from malignant granuloma, malignant tumors and specific granulomas.
Malignant granuloma: mostly begins in the nose, then gradually spreads to the midline of the face. It is a rare granuloma with clinical necrotizing ulcers. The pathological examination is mostly chronic non-specific granulation tissue and necrosis. Inflammatory cells infiltrate the components. According to clinical and pathological features, the disease is presumed to be a tumor.
