鼻是呼吸道的门户,对吸入的空气有加温、加湿和清洁功能。季节变换,气温、湿度、气压发生较大的变化,加上空气污染、人口密集等因素,抵抗力弱的人就容易感冒,而感冒又容易引发或加重鼻炎。鼻炎表现为打喷嚏、流鼻涕、鼻塞,头痛,很多患者常常误把鼻炎当作感冒来治疗。由于没有针对病因进行治疗,导致急性鼻炎、慢性鼻炎、过敏性鼻炎等疾病迟迟不愈,并可引起鼻窦炎、咽喉炎、气管炎等,增加了不少痛苦。一些患者会因为鼻炎引起头痛、头脑不清醒,致使工作、学习效率低下。当鼻炎影响到鼻腔的生理功能时,患者会出现呼吸障碍,引发血氧浓度降低,并影响其他组织和器官的功能与代谢。鼻炎是指鼻腔粘膜发生炎症,表现为鼻腔充血或者水肿,患者经常会有鼻塞、头痛、流涕、鼻痒、喉部不适、咳嗽等症状。临床常见鼻炎主要有急性鼻炎、慢性鼻炎、过敏性鼻炎。急性鼻炎,是由病毒或细菌感染所致,初期由于鼻粘膜血管扩张,腺体分泌增加,流清水样鼻涕,3-4天后由于渗出物淤积于粘膜表面,形成脓性分泌物,也就是白色的粘稠鼻涕。慢性鼻炎,多为急性鼻炎治疗不及时或不彻底转变而来。表现为:粘膜肿胀,分泌物增多,呈白色或黄色脓性鼻涕,持续时间较长,常拌有鼻塞和头痛,并且在感冒时症状加重。过敏性鼻炎,是一种变态反应性疾病,因机体对某些物质如花粉、尘螨等过敏引起。本病起病较急,患者有频繁打喷嚏、流大量清水样鼻涕、鼻痒等症状,持续时间较短。预防鼻炎的发生应从日常生活着手,特别是预防慢性鼻炎的发生,要重点做好对急性鼻炎的治疗。急性鼻炎如治疗不及时或不彻底,往往转化为慢性鼻炎。而急性鼻炎是由呼吸道病毒感染引起,预防应侧重以下几点:经常参加体育锻炼,增加抵抗力,注意保暖,预防感冒。居室经常通风,保持一定湿度。饮食起居有规律,避免烟、酒、辛辣食品、多吃蔬果。保持乐观开朗的情绪,避免精神刺激和过度疲劳。避免频繁进出温差悬殊的环境。避免接触容易引起过敏或有刺激性的物质。治疗感冒引起的急性鼻炎,除了在发病早期服用感冒药物,还应加用粘液促排剂;因细菌感染出现并发症的患者,需加用抗生素,局部使用“血管收缩剂”滴鼻,以减轻粘膜肿胀、改善鼻腔通气引流。治疗慢性鼻炎,通常采用“粘膜收缩剂”滴鼻,生理盐水冲洗鼻腔,口服“鼻炎片”等中成药;严重的患者需手术治疗。治疗过敏性鼻炎,可口服抗组胺药物和鼻局部喷类固醇激素,过敏原皮肤试验明确过敏原及脱敏治疗。鼻炎患者应该在医生的指导下正确使用滴鼻液,不可长时间大量滥用,以免引起药物性鼻炎或加重原有鼻炎的病变程度。鼻塞、流涕、头痛、头昏……当出现这些现象时,应该立即到耳鼻喉科检查,明确诊断,及早治疗。(作者为上海市第八人民医院耳鼻咽喉科主任医师;专家门诊:周二、周四上午)
Doctors Try Balloon Fix on Sinusitis医生们用球囊装置治疗鼻窦炎In a Preliminary Study, Doctors Are Trying a Balloon Fix to End Misery of Sinusitis在一项初步的研究中,医生们正在试用一个球囊装置,终结神秘难治的鼻窦炎WASHINGTON - It's like an angioplasty to clear out clogged sinuses. A new procedure lets doctors snake a balloon up the noses of chronic sinusitis sufferers, stretching their sinus passages to help them breathe easier with less pain than the standard sinus surgery that 350,000 Americans undergo each year.这个手术有点像通畅鼻窦的血管除窄成形术。一项新的手术治疗让医生们用一个球囊潜行进入慢性鼻窦炎患者的鼻腔,扩张开鼻窦通道,帮助患者呼吸通常,而又比标准的鼻窦手术所受痛苦更少。每年有35万美国人要做鼻窦手术。No one yet knows if balloon sinuplasty works as well as a surgical fix. Only about 100 doctors around the country are trained to offer it, and research is just beginning to track its effectiveness and determine who is a good candidate.But if sinuplasty proves itself, it promises a long-awaited middle ground between medications and surgery for thousands of patients seeking relief from the misery of repeated sinus infections."Clearly sinuplasty will not replace surgery for every patient," cautions Dr. Michael Friedman, an otolaryngologist and chief of head and neck surgery at Chicago's Rush University Medical Center, who heads the first study that will compare the treatments."But I think there's a huge number of people who could benefit from this," he adds. "It's really the most exciting thing that's happened in our specialty in probably 15 years."Sinusitis is an inflammation or infection of the straw-sized passages that drain each of the sinuses that surround the nose and eyes. It can cause swelling and facial pain, debilitating headaches, and a sometimes pus-like nasal congestion.鼻窦炎是分布在鼻子和眼睛周围的窦腔引流管道的炎症或感染,窦腔引流管道只有稻草杆粗细。鼻窦炎能引起肿胀和面部疼痛,使人感到虚弱的头痛,有时还有脓性物质阻塞鼻腔。Acute sinusitis, triggered by colds or bad allergies, usually clears up within a month. But more than 30 million Americans suffer from chronic sinusitis, meaning symptoms last longer than two months or regularly recur. Patients repeatedly try antibiotics, decongestants or steroid-containing nasal sprays, but about a quarter are thought to get inadequate relief.感冒和过敏可以触发急性鼻窦炎,一般在一个月内会痊愈。但3千万以上美国人患上了症状持续超过2个月,经常复发的慢性鼻窦炎。病人反复使用抗菌素,消除鼻充血的药物,或者含激素的鼻喷剂,但1/4患者恢复效果不佳。It's a vicious cycle: Each infection further narrows the already small drainage openings. Then the next cold or allergy attack that causes nasal congestion can be enough to block proper sinus drainage and spur yet another infection.这是一个恶性循环。每次感染都会使得原本细小的鼻窦开口更狭窄。然后,下一次感冒和过敏发作,造成鼻腔充血,阻塞正常的鼻窦引流,会刺激另一次感染。In severe cases, doctors snake special tools up the nose to enlarge those sinus openings by cutting out inflamed tissue and bone. It's highly effective only about 20 percent of patients need repeat surgery but is painful and can cause a week of swelling plus scar tissue that may reblock the sinus.在一些严重的鼻窦炎病例中,医生用特殊的器具深入鼻腔,通过切除感染的组织和骨质,来扩大鼻窦开口。这项手术对20%的患者很有效,但需要经常做,而且疼痛,造成鼻腔一周的肿胀,结痂组织也会阻塞鼻窦。The new balloon device is snaked to the same spot, but there's no cutting. Instead, inflating the balloon aims to stretch that sinus opening back to its original size or a little bigger, letting air into the sinus to help antibiotics finally flush out infection and end the sinusitis cycle, explains Friedman.这项新的球囊装置深入鼻腔的同一部位,无需切割,只要扩张球囊,让鼻窦开口回复到原来大小,或者更大些,让空气进入鼻窦,帮助抗菌素最终消除感染,终结鼻窦炎症循环。Created by a physician-turned-medical device inventor frustrated by his own sinusitis, it's similar to the way doctors use balloons to push back clogs in heart arteries. Thus, the Food and Drug Administration cleared sale of Acclarent Inc.'s device last summer based mainly on a study of 10 people that found no safety concerns.How well does it work? There's no research to tell, says Dr. David W. Kennedy of the University of Pennsylvania, who led an examination of sinuplasty for the American Academy of Otolaryngology and complains that FDA should have required more evidence to back a procedure so different from standard sinus treatment.Many patients have growths, called polyps, that a balloon can't get rid of. The balloon doesn't fit in every sinus. Like surgery, it often requires general anesthesia to ensure the patient doesn't wiggle. And severe patients often have bone inflammation that must be removed, not just pushed aside, Kennedy stresses.Doctors are anxiously awaiting results, due in September, of an Acclarent study tracking how more than 100 sinuplasty recipients fared. But to compare sinuplasty to standard treatments, Friedman, who has no financial interest in Acclarent, has begun a study that randomly assigns 80 sinusitis sufferers to surgery, sinuplasty or continued medication.Even Kennedy acknowledges that sinuplasty, with less pain and scar tissue, may prove useful for milder sinusitis cases or to buy time for people hoping to postpone surgery.Even if the effects don't last as long as a surgical fix, "I would do this five times compared to having the other procedure done once," says Lynn Sawyer, a Graniteville, S.C., nurse who sought the new procedure after watching surgery patients' painful recoveries.Her latest sinusitis bout had lasted eight months, causing dizziness, severe eye pressure and repeated migraines. She experienced relief within a day of her December sinuplasty: "It was like being in a dark room and somebody opened up shades, it made that much difference," she recalls.Three months later, she's thrilled to remain congestion-free despite heavy spring pollen.
受访专家:上海市第八人民医院耳鼻喉科主任张建华导语:目前,在我国的许多城市已经开展新生儿听力筛查,从出生后干预移步到出生前预防,通过产前基因诊断或孕前遗传学检查与咨询,就可得知胎儿是否会出现先天性耳聋。对爸爸妈妈而言,此举无疑为宝贝听力健康更早撑起了一把保护伞。然而值得关注的是,听力筛查所起到的作用并不等同于宝贝今后听力就不会发生问题。保护好宝宝的耳朵还是爸爸妈妈不可忽视的任务。引起宝宝听力下降的原因与成年人相比,宝宝的耳朵发育还不完全,耳道结构有其自身的特点,比如连接中耳与鼻咽部有一根通气管,医学上称之为咽鼓管。小宝宝的咽鼓管与成年人相比具有短、平、宽的特点,所以,小朋友一旦鼻腔或鼻咽部有炎症感染,极易通过咽鼓管侵入中耳,引发中耳炎。而家长对宝宝耳朵护理不当,也会发生不同的耳病,轻则引起耳疼不适,重则可以形成鼓膜穿孔、持续流脓、听力受损。上海市第八人民医院耳鼻喉科主任张建华表示,在生活中引起宝宝听力下降的原因分为两类:其一是先天性的,妈妈在怀孕时受病毒感染或其他环境因素,比如孕妈妈长时间受噪音影响,由于胎儿在发育过程中听觉系统非常敏感,很可能造成宝宝听力受损。其二是后天性的,最常见的、危害最大的就是氨基糖甙类抗生素引起宝宝听力受损,这些药物包括庆大霉素、链霉素、妥步霉素、卡那霉素等等,有些宝宝对此类药物非常敏感,用药需非常谨慎。再者就是一些耳病没有及时被爸爸妈妈发现后去医院就诊,导致宝宝部分听力下降。宝宝常见耳病正确处理法很多宝宝听力受损是由于不正确的耳朵“护理”引发耳病所致,所以要拥有耳聪目明的宝贝,爸爸妈妈还需了解一旦宝宝的耳朵不小心生病了该如何正确处理。外耳道炎:敏敏的宝宝5个月,吐奶后敏敏就用棉花棒给宝宝清洁耳朵,不小心擦破了一点点,刚开始觉得没事,没想到没过多久,宝宝的耳道开始有点红肿,小手一直放在头边不让别人碰左耳,碰到就开始哭闹。于是敏敏带着宝宝去医院就诊,结果是得了外耳道炎。 张主任说,宝宝的外耳道表面皮肤非常薄而且娇嫩,用棉花棒清洁时极易碰伤,引起外耳道皮肤急性发炎。还有在给宝宝洗澡洗头的时候,如果水不小心流到外耳道,而外耳道的皮肤又有破损,也会引起炎症。急性外耳道炎多表现为耳朵疼痛,宝宝会不让人碰耳朵,比较严重的会少量流脓血。处理:爸爸妈妈尽量不要自己用药。有些家长自行用硼酸洗剂去为宝宝在外耳道破损的地方的消毒是比较危险的做法,因为小宝宝的鼓膜非常较脆弱,一旦使用不当,硼酸洗剂流到鼓膜,可能会导致鼓膜穿孔。如果一定要使用外用药缓解宝贝疼痛,可以选择水溶性的滴耳液。预防:外耳道炎多数是因给宝宝洗头、游泳时的污水或宝宝吐奶后的奶汁不小心流入外耳道,然后爸爸妈妈护理不当,细菌乘机侵入所引起。所以一旦可以消毒棉棒蘸一点生理盐水轻柔的擦一下。另外,不要用发卡、挖耳勺等物为宝宝掏耳朵,以免不小心划破了外耳道皮肤引起感染。 耵聍栓塞小雨的宝宝今年3岁,但她发现家人和宝宝说话他时常好像听不见似的,要稍微大声点,他才回应,有时候又好像瞎了一跳,虽然宝宝不哭闹,也没有发烧,但小雨还是急忙带着宝贝到医院五官科检查了一下,结果原来是外耳道的耳屎堵住了。耵聍,俗称耳屎。爸爸妈妈带宝宝游泳或给他洗头、洗澡时,耳朵里灌进了水,就可能会把积存在耳朵里的耳屎泡软胀大后堵塞耳道。这时宝宝耳朵多会发闷,听力不好。出现这种情况,最好到医院检查一下,医生会利用仪器把泡软的耳屎取出来。家长不要自己贸然动手为宝宝去掏耳屎,宝宝的耳道很窄,爸爸妈妈在看不清的情况下,稍有不慎,易划破宝宝的外耳道或是损伤耳内鼓膜。并且如果挖耳工具若没有做好消毒,还易使细菌进入耳朵,引发炎症。处理:不需要自行为宝贝“治疗”,可以定期请医生清理耳道,以免阻塞耳道影响听力。预防:给宝宝洗澡洗头时尽量让宝宝的头在上面,以免水倒灌入耳朵,如果一旦有水进入宝贝耳道,也没必要特意用工具去处理,一方面爸爸妈妈掌握不了耳道深浅,可能会伤及宝宝外耳道,另一方面只要让宝宝稍微活动一下头部,水会自己流出来,即使不活动也会自然蒸发。化脓性中耳炎:小虎的妈妈由于给宝贝喂奶姿势不当,宝宝吐奶后不久,出现了发烧、呕吐症状、还不停的用小手抓耳朵摇头,后来耳朵居然开始流脓出来,便急忙去看耳科医生,结果是化脓性中耳炎。处理:一般急性中耳炎,细菌破坏力比较强,脓也比较多,鼓膜受到压迫缺血坏死穿孔后,脓就顺着鼓膜的穿孔流到外耳道,然后再从外耳道流出来,如果不得到彻底治疗,转变成变成慢性中耳炎,听力肯定受影响。预防:由于婴幼儿咽鼓管具有短、平、宽的解剖特点,妈妈在哺乳时要注意哺乳的姿势,一旦哺乳宝宝时位置不当,如平卧吮奶,乳汁会顺着从咽鼓管流入中耳,而乳汁是很好的细菌培养场所,容易引发中耳炎。因此,在喂宝贝吃奶时尽量把他的头部抬高一些,不要让他躺着吃奶。喂完后要抱起宝贝轻拍后背,不要立即平卧,以免呛奶后乳汁又顺着咽部,经咽鼓管进入中耳,引发中耳炎。分泌性中耳炎:时下是感冒的高发时期,而感冒如果不及时治疗的话,宝宝的耳朵也会成为殃及之地,宝宝的鼻咽部有一个腺样体,感冒后腺样体会增大肿起来,引起咽鼓管阻塞,中耳就进不去空气了,中耳气压低会引起分泌性中耳炎。如果宝宝感冒了几天后,发现有听不清别人说话的现象,到医院一查就有可能就是分泌性中耳炎,而分泌性中耳炎是宝宝致聋的主要原因之一,且发病率有上升趋势。处理:分泌性中耳炎如果不及时治疗,会导致小儿患者听力减退,严重时还会影响预防:分泌性中耳炎由于症状不明显,宝宝大多没什么感觉,爸爸妈妈如果不注意观察可能就会耽误治疗,最终导致宝宝听力损伤,所以家长在平时和宝宝说话时,要在意看他对声音的反应,如果宝贝反应迟缓,注意力不集中,好像听不清楚你在说话,同时宝宝又有感冒病史的话,要及时到医院耳鼻喉科做检查。怎样保护小朋友的耳朵1正确清洁耳朵爸爸妈妈平时不要随便为宝宝清耳屎以免损伤耳朵,如果要为宝宝清洁耳朵,可以用清洁的消毒棉花棒,加点生理盐水,在宝宝的外耳道口轻柔的清一清,切勿伸进去太深,以防伤到宝宝的耳鼓膜,引起听力损伤。2预防上呼吸道感染积极预防感冒或尽可能缩短感冒周期是避免宝宝患中耳炎的最佳措施。一旦宝宝因感冒引起鼻窦炎或鼻塞得比较厉害,睡觉时可将头部垫得高一些,以便积聚于鼻腔内的黏液不至于流到咽鼓管内,或使用一些滴鼻剂帮助通气及鼻窦引流,促进炎症消散以免引发中耳炎。爸爸妈妈平时要注意观察宝贝的状态,一旦宝宝有耳痛、发烧、哭闹、有鼻腔鼻窦疾病,流脓涕、鼻子不通气,要及时就诊,在用药上也要注意不要用对耳朵有毒性的药物。3防止异物飞入如果有小昆虫飞入或爬进宝宝的耳朵,小昆虫在宝宝的耳朵里活动,会宝贝耳朵疼痛,同时他也会觉得很恐怖,这时爸爸妈妈只要用一点食用油,让小昆虫缺氧窒息,再到医院去处理即可,不要用镊子或钳子去夹,以免不小心损伤宝贝的耳朵。
慢性鼻窦炎是耳鼻咽喉科多发疾病,患者经常流脓涕、鼻塞、头痛、记忆力减退,给生活、工作带来诸多不便和影响。常因鼻窦口狭窄或阻塞,窦腔内积脓不易排出。目前的治疗方法多是在鼻内窥镜下手术切除鼻窦口周围的黏膜和骨组织,开放鼻窦引流出积脓。但切除手术造成解剖结构的破坏、窦口引流通道黏膜的损伤、术后术腔黏膜的创伤性水肿和炎症、术中难以控制的出血、手术导致的医源性损伤以及术后瘢痕形成等仍然难以完全避免。因此,切除手术并非完美的鼻窦外科手术方式。鼻窦球囊扩张术,是将一个小而柔软的气囊插入鼻窦通道,利用气囊的膨胀使因发炎而缩小或闭塞的的通道恢复到原来的大小或稍大一些,使空气顺利进入鼻窦,积脓经开放的窦口流出,不切除任何组织而达到治疗的目的。2008年,美国医生应用鼻窦球囊扩张术治疗慢性鼻窦炎1036例,术中和术后未发生与球囊导管相关的重大不良事件,95.2%的患者有鼻窦炎症状的改善。从而证实球囊扩张术好的疗效和安全性。鼻窦球囊扩张术的主要临床优势包括:①球囊导管扩张术导致的创伤最小,黏膜破坏最小,几乎无出血,因此,术后最大限度的减少了粘连的形成和开口的再狭窄,术后所需清创次数也明显减少,进而提高了慢性鼻窦炎的治愈率;②由于手术仅扩大相应的窦口,因此最大程度的保存了鼻窦的正常结构,对颅底和眼眶的骨质不构成任何损伤,安全性好;③术后不需要术腔填塞,术后用药减少,住院时间缩短或不需住院。