New concept of sinusitis treatment
With the increasing pace of people’s lives and drastic climate changes, the trend of chronic rhinitis and sinusitis patients is on the rise, followed by various types of corresponding treatment modalities, but the results achieved in the clinic are uneven, the following we talk about their views on local treatment such as laser, microwave and freezing.
The nasal cavity is an irregular cavity, and narrow and complex structure, with ventilation, filtration, cleaning, heating, humidification, olfaction and other functions, the nasal cavity is mainly through the nasal mucosa mucous cilia clearance system to maintain its normal physiological function and achieve the role of cleaning, various causes of cilia movement dysfunction can make the nasal cavity and sinuses easy to infect, increasing the probability of rhinitis and sinusitis, so the maintenance of nasal mucous The cilia removal system is a prerequisite for the normal function of the nasal cavity.
Laser is the use of laser cohesion heat generated by the direct cauterization of nasal lesions to achieve the purpose of treatment, microwave, plasma is generally similar to the principle of action, as for freezing is through the coagulation or vaporization of hypertrophic tissue and make it smaller, so that the nasal cavity is open. Throughout these treatments are mainly to destroy the nasal mucosa, so that the enlarged nasal mucosa tissue atrophy, so as to solve the role of nasal ventilation and sinus drainage, but these treatments are very easy to damage the normal function of the nasal mucosa cilia clearance system, reduce the local resistance of the nasal cavity, can only temporarily relieve the symptoms, easy to relapse and more need to re-treatment, if too much long-term use of such therapy, but make the symptoms more and more If such treatment is used too much for a long time, the symptoms will become more and more serious.
With the continuous development of science and technology, nasal endoscopic “cold instrument” surgical treatment has become the latest means of treating rhinitis and sinusitis, which is done with the help of a camera and surveillance system that magnifies the nasal cavity and sinus lesions on a TV screen.
The surgeon can remove the focal tissue more precisely through the screen, while retaining the normal nasal mucosa to the maximum extent and ensuring its normal nasal cilia physiological function, with good surgical effect and less damage and side effects, which can better solve the problem of nasal ventilation and sinus drainage and reduce or even eliminate the clinical symptoms of patients. It can cure the disease and at the same time retain the normal nasal function to the maximum extent, so as to relieve the transient pain of nasal congestion, runny nose and headache for the majority of rhinosinusitis patients and pay more attention to the long-term maintenance of the normal defense function of the nasal cavity, so as to achieve the purpose of curing part of rhinitis and sinusitis.
New method of treatment for auricular pseudocysts
Pseudocysts of the auricle are a common disease in otorhinolaryngology, named because they grow in the auricular region and are pathologically found to have no epithelial lining in the wall of the cyst.
From the first cyst puncture and fluid extraction followed by pressure bandaging or local compression, intracapsular injection of drugs, surgical excision of part of the anterior wall of the cyst to laser perforation of the cyst wall to release fluid in recent years, no less than a dozen, it is generally believed that surgical excision of part of the cyst wall for “open window” type drainage is the most effective, and the microwave and laser perforation derived from this can be regarded as the most effective treatment for surgery. “In essence, they enable continuous drainage of the bursa fluid, eliminate the fluid in the bursa, and create good conditions for the separated auricular cartilage to heal again.
Although the efficacy of this type of treatment is reliable, there are many relative shortcomings.
1. The operation is not concise enough;
2. Treatment also requires special equipment: microwave and laser;
3, “open window” after several drug changes and bear the corresponding medical costs;
4, increased the risk of secondary infection;
5.The course of the disease is difficult to control, the healing time of the “window” is usually longer than the actual drainage time of the cystic fluid, and the length of the treatment depends to some extent on the healing time of the “window”.
Complete drainage of the cystic cavity is the most effective and basic requirement for the treatment of auricular pseudocysts. Compared with the classic surgical “open window”, it has the advantages of “closed” drainage.
1, simple to take materials, only a pair of intravenous infusion set.
2, simple operation: only a local puncture at the cyst is needed.
3, the course of the disease is shortened and easy to control, the length of treatment is entirely determined by the cyst fluid drainage time, after the cyst fluid drainage and cyst cavity no longer exuding, the cyst can be healed, the treatment is over.
4.Less trauma, only one local puncture is needed, so the chance of infection is small.
5.The efficacy of treatment is easier to observe. When the drainage fluid in the transparent infusion tube is no longer produced, the needle can be removed to wait for the cavity to heal. This method can minimize the risk caused by improper treatment of auricular pseudocysts and has the ability to manage the whole situation of auricular pseudocyst treatment.
A “new” perspective on the treatment of peri-tonsillar abscesses
A peri-tonsillar abscess is a purulent inflammation in the peri-tonsillar space. The early stage is cellulitis, called peri-tonsillitis, followed by abscess formation, called peri-tonsillar abscess. The disease is often secondary to acute tonsillitis or an acute attack of chronic tonsillitis. It is caused by blockage of the tonsillar fossa, especially the superior tonsillar fossa, poor drainage, and deeper development of the infection, which penetrates the tonsillar peritoneum and invades the peri-tonsillar space. The common causative agents are mostly Streptococcus haemolyticus or Staphylococcus aureus. It is mostly seen in adults.
In order to prevent recurrence, tonsillectomy should be performed. The traditional view is that surgery should be performed only 2 to 3 weeks after the acute inflammation of the tonsils has subsided.
However, we believe that: after the diagnosis is confirmed or the pus is excised, the affected tonsils can be removed in a one-time operation under the control of sufficient antibiotics. At this time, the pus has separated between the tonsillar peritoneum and the tonsillar fossa, so it is easier to peel off the tonsils, less bleeding and less pain, and after the tonsils are excised, the pus cavity is completely open to drain the pus thoroughly, which is easy to cure.
The one-time surgery can reduce the pain and the corresponding medical and economic burden caused by repeated local puncture and incision to drain the pus, and it can also avoid the difficulty of stripping the tonsils due to scar formation when the surgeon operates again. The recurrence rate is almost 0%.
New” weapon against fish spikes in the throat
Fish spikes in the throat are one of the common emergencies in otorhinolaryngology. For fish spikes located in the upper and middle tonsils or at the root of the tongue near the tongue, it is relatively easy to remove them with forceps, while foreign bodies located deeper in the lower pole of the tonsils, the large part of the tongue root, the lateral wall of the lower part of the oropharynx, the laryngopharynx and the larynx need to be examined and removed with indirect laryngoscopy, but some patients are particularly sensitive due to the pharyngeal reflex.
However, some patients are unable to cooperate with the examination even after surface anesthesia, or because of short tongue ligament, restricted tongue extension, tongue hypertrophy, high arch of tongue back and inability to expose the epiglottis valley when pronouncing the “clothes” sound, which makes the patient unable to find the foreign body during the indirect laryngoscopy. In addition, the indirect laryngoscope itself has lower brightness and smaller quadrant of field of view, which makes it difficult for doctors to detect and clamp foreign bodies, delaying the diagnosis and even inducing serious complications such as parapharyngeal abscess, esophageal foreign body and hemorrhage.
With the wide application of endoscopic technology in clinical work, the examination of foreign bodies in the pharynx under electronic laryngoscope has many advantages.
1.When performing electronic laryngoscopy, the operator usually observes through the monitor, and after the magnification of the monitor (8 times), it is easier to find the foreign body that is small or embedded between the tonsils of the enlarged tongue root;
2, the electronic laryngoscopy can take the nasal pathway, reduce the pharyngeal reflex, so that the patient is more tolerable, but also to avoid the restriction of mouth opening and can not carry out the examination of the laryngopharynx and other parts;
3, electronic laryngoscopy, the patient can take the supine position, which is beneficial to relieve tension and easier to cooperate with the examination;
4.When a foreign body is found by electronic laryngoscopy, a small pharyngeal biopsy forceps can be immediately introduced through the mouth of the suction device, and the foreign body can be accurately and quickly clamped under the accurate positioning of the electronic laryngoscope, causing little damage to the adjacent tissues. Therefore, for patients who cannot cooperate with indirect laryngoscopy or who do not find foreign bodies after examination, electronic laryngoscopy should be performed. Electronic laryngoscopy for foreign body removal is a useful supplement to traditional foreign body treatment methods in the pharynx and is superior to traditional methods in many aspects.