(Disclaimer: This article is for general use only. To protect Mr. Li’s privacy, the information in the following content has been processed)
Abstract: This case is about 40-year-old Mr. Li, who came to our hospital because of “nasal congestion and intermittent nasal bleeding for 6 months, and recently the amount of nasal bleeding has increased and is more frequent than before”, and he was asked about his condition in detail and advised to further improve the lateral nasopharyngeal film. After surgery + medication, the nasal congestion and nasal bleeding were controlled and the treatment effect was good.
Basic information】Male, 40 years old
Type of disease】Rhinorrhea
Hospital】Northern War Zone General Hospital
Date of consultation】April 2021
Treatment plan】Surgical treatment (nasal endoscopic septal correction) + medication (cefuroxime sodium for injection, eucalyptus pinene enteric soft capsule, budesonide inhalation aerosol, nasal spray of azulfidine hydrochloride)
[Treatment cycle] Outpatient treatment, 1 week after outpatient follow-up
Treatment effect】After the operation, Mr. Li’s nasal bleeding was cured and his nasal congestion improved.
I. Initial consultation
Mr. Li described his medical history in the outpatient clinic. He had been suffering from nasal congestion and recurrent nasal bleeding on the right side for 6 months, and the bleeding was relatively small at first. But recently, the onset of nasal bleeding is frequent, the bleeding volume is significantly increased compared to before, the bleeding time is prolonged, Mr. Li began to worry about his body, so he came to the hospital urgently. Examination of the anterior rhinoscope: the nasal septum obviously had a bony ridge to the right, local contact with the inferior turbinate, and the mucous membrane in the contact place was seen to be broken and locally oozing blood. Complete nasal CT: the nasal septum was obviously deviated to the right, bilateral inferior turbinates were enlarged, and no abnormality was seen in the sinuses. According to Mr. Li’s symptoms and examination, he is now diagnosed with rhinorrhea and deviated nasal septum, and surgery is recommended.
(Nasal CT)
II. Treatment history
After admission to the hospital, further relevant laboratory tests were done, mainly including: blood routine, liver and kidney function, coagulation function, immune-related indexes, ECG, chest X-ray, etc. to exclude contraindications to surgery. Mr. Li did not see any significant abnormality after the examination, and then he was scheduled to undergo nasal endoscopic septum correction surgery under general anesthesia to ablate the hypertrophied inferior turbinates on both sides and to move the bilateral inferior turbinate fractures outward, so that the bilateral nasal cavity became unobstructed and the raised bone ridge was treated and would not come into contact with the inferior turbinates, so that it would not bleed again. After the surgery, Mr. Li was given a nasal tamponade to prevent nasal adhesions and nasal bleeding, and cefuroxime sodium for injection to prevent infection. In addition, it was recommended to also take eucalyptus pinene enteric soft capsule orally to promote the outward drainage of nasal secretions. And apply nasal irrigator to further clean the nasal cavity. If turbinate edema is obvious, budesonide inhalation aerosol and nasal spray of azulfidine hydrochloride can be used to improve nasal congestion and alleviate the symptoms of runny nose.
III. Treatment effect
On the 2nd day after the surgery, the patient removed the expansion sponge filled in the nasal cavity in the outpatient clinic. On examination: the bone ridge of the deviated nasal septum had been removed, there was no obvious deviation of the nasal septum, no hematoma in the nasal septum, no signs of infection, a small amount of blood crust adhered to the nasal cavity but no active bleeding. Mr. Li reported: good nasal ventilation, no active nasal bleeding at the same time, occasional nasal snot with some old blood in it.
IV. Notes
We are glad that after surgical treatment + medication, Mr. Li’s nasal bleeding symptoms disappeared. After surgery, it is recommended to eat a light diet, avoid spicy, stimulating and hard foods, and avoid excessive chewing to prevent postoperative bleeding in the nasal cavity. Avoid smoking to reduce the stimulation of the nasal mucosa. Avoid drinking alcohol to avoid disulfiram-like reactions due to postoperative application of cephalosporin antibiotics. Medication can be continued with oral eucalyptus pinene enteric soft capsule to promote outward drainage of nasal secretions and application of nasal irrigator to further cleanse the nasal cavity. If turbinate edema is obvious, you can use budesonide inhalation aerosol and nasal spray of azulfidine hydrochloride to improve nasal congestion and reduce the symptoms of runny nose. Avoid blowing the nose hard in daily life to avoid causing nasal septal hematoma. After 1 week of treatment, it is recommended to review again in the outpatient clinic to clarify whether there is any infection in the nasal cavity and to clarify the recovery of mucosa in the operated area.
V. Personal insight
Rhinorrhea, also called epistaxis, is a common disease in ENT clinic. If there is a small amount of bleeding repeatedly for a long time, the cause should be actively searched for; for a large amount of bleeding, it is usually necessary to go to ENT clinic to stop the bleeding immediately and then further search for the cause. When nasal bleeding, try not to swallow the blood to avoid stimulating the stomach to produce nausea and vomiting. When bleeding, you can pinch the bilateral nasal wings with both hands to play the role of compression to stop bleeding, or fill the nasal cavity with cotton balls inside. It is known from this case that if nasal bleeding occurs, do not delay and seek immediate medical attention to find the primary cause, and after active treatment, you can also reap good treatment results.