Patient: I am a 20-year-old male with a two-year history of chronic rhinitis simplex alternating nasal congestion and intermittent nasal congestion I can see in the mirror that my nostrils have edema blocking the nasal cavity, causing difficulty in breathing No headache, no runny nose Only one nostril is blocked When I sleep with my body on my left side, my right nostril is blocked and the other way round, my left nostril is blocked. In the summer, especially when it is hot, the congestion comes up immediately. The doctor did not recommend plasma surgery and prescribed dexamethasone ephedrine nasal drops (2 bottles prescribed) and compound dahurica rhinitis granules (2 weeks prescribed). The doctor prescribed me 2 weeks of ephedrine, but I need to take ephedrine three times a day, do I need 2 weeks of ephedrine? Do I need to undergo plasma cryoablation? If not, how should I treat it? Do I need to take the dexamethasone ephedrine nasal drops prescribed by the doctor for 2 weeks? If I don’t treat it, will it continue to worsen and what type of rhinitis will it become if it is most severe? I would like to wish Dr. Yu a happy life and all the best. A patient who is suffering from nasal congestion, how should I register for your number on Friday? The numbers given at the registration office are all random.
Yu Hongmeng, Department of Otorhinolaryngology, Shanghai Five Gwangs Hospital: Plasma treatment is not recommended.
Patient: Thank you for taking time out of your busy schedule to give me an answer. Dr. Yu, what is your reason for not recommending plasma surgery for this condition? Thank you! How should I treat my condition without plasma surgery? I’m only 20 years old and I don’t want my life to be ruined by rhinitis.
Yu Hongmeng, Department of Otorhinolaryngology, Shanghai Five Gynecological Hospitals: When patients with rhinitis need surgical treatment, one of the things they often ask me is: Can you help me with laser or low-temperature plasma surgery, which often makes me wonder why laser, low-temperature plasma and microwave treatment are so deeply implanted in the hearts of patients? In order to solve this mystery, I often ask patients why they think this way, and summarize their answers to come up with the result that laser, low-temperature plasma and microwave are a mysterious high-tech thing to patients, which can achieve a one-time cure. But are they really as effective as patients think they are? Before answering this question, I would like to briefly introduce the principle of these treatments to patients: First, the principle of microwave therapy: the use of electromagnetic waves, so that the polar molecules in the irradiated tissue (mainly water molecules) with the microwave frequency of high-speed rotation, mutual friction generated heat, through this internal heating coagulation necrosis, destruction of the epithelial layer of the nasal mucosa for the purpose of ablation. Laser treatment: the use of excited radiation light generated by photothermal action on the tissue, the treatment temperature is high (more than 150 ℃), through the destruction of the epithelial layer of the nasal mucosa for ablation. Third, low-temperature plasma therapy (a kind of radiofrequency treatment): the use of high-frequency electromagnetic waves at low temperature (about 40-70 ℃) to ablate the tissue, through the conductive medium (salt) around the electrode to form a highly aggregated plasma area, crushing the organic molecules in the tissue molecular chain, so that the molecules and molecular separation, tissue volume reduction, so that the tissue fixed ablation. Ablation is mostly performed by destroying the subepithelial layer of the nasal mucosa. The advantage is that there is less heat penetration. It can be seen that any of the above treatments is a destructive treatment for the nasal mucosa and must cause varying degrees of damage to the function of the mucosa. It seems that the side effects of low-temperature plasma treatment are less, and many people think that low-temperature plasma does not act on the epithelial layer of the mucosa, but only on the subepithelial layer, so it is much less traumatic. Practice is the only criterion to test the truth. From the clinical practice, I found that after the above treatment, many patients felt that the nasal ventilation improved significantly in the short term due to the ablation and atrophy of the nasal mucosa. However, after a long time, the patients realized that their initial choice paid an irreversible price for the future treatment. Many patients still feel that their nasal cavity is not ventilated after some time of treatment, and they even have symptoms such as nasal dryness, excessive nasal discharge, nasal bleeding, etc. When I examine these patients, I often find that the mucous membrane of the nasal cavity is obviously atrophied and the nasal cavity is very spacious. It is reasonable that such a spacious nasal cavity should be ventilated, but the patient just feels a significant nasal congestion, why? In fact, the physiological function of the nasal cavity is closely related to the function of the nasal mucosa. Therefore, it is not easy to take for granted that the problem will be solved by ablating and shrinking the nasal mucosa through microwave, laser and low-temperature plasma, etc. The result may be the opposite. Of course, microwave, laser and low-temperature plasma are not useless in the treatment of nasal diseases. For some particularly hypertrophic turbinates, the appropriate use of the above-mentioned technology for ablation treatment (should not be excessive) is also effective. In addition, microwave, laser and low-temperature plasma are more effective in the treatment of rhinorrhea and can be used to close the bleeding point with the assistance of nasal endoscopy. Therefore, I suggest that patients should think twice before choosing microwave, laser, and low-temperature plasma for the treatment of nasal disease.
Patient: Dr. Yu, a thousand words are not enough to express my gratitude. I would like to ask how should I treat my chronic simple rhinitis? The symptoms are always nasal congestion, with a mirror you can see edema inside the nasal cavity blocking breathing difficulties, alternating nasal congestion, mainly in the right nostril nasal congestion, hot weather congestion particularly bad, really very very thankful!
The patient: Hello, I am a patient in Henan who you diagnosed this afternoon, my nasal cavity in the study of the time when the sick and anxious by the wandering doctor played many injections of unknown drugs, today, as you said, the nasal mucosa are ruined, I want to ask you two questions, 1, I am not clear about the function of the nasal mucosa, is not my I don’t know the function of the nasal mucosa, is my nasal mucosa no longer functional, so the air I breathe in is not filtered by my nose or something, what is the biggest harm to me from the destruction of the nasal mucosa, is my nasal mucosa more traumatic than some patients who had plasma or microwave surgery? What is the worst consequence for my nose if I give up the treatment? Secondly, is the nasal spray and saline prescribed today to be done at the same time or at intervals of one or two hours? I’m worried that if I wash my nose with salt water immediately after spraying, the spray will be washed away by the salt water and have no effect. If I have to do it separately, how long should I do it, and should I spray my nose first or wash it with saline? I’m sorry to bother you again, I’m only 20 years old, I really can’t imagine and admit that my nasal mucosa has been destroyed, when I know that my nasal mucosa will never recover in my life, I really even have the heart to die, but I haven’t repaid my parents, I want to live.
The mucosal trauma is relatively large, after cleaning and medication, the effect will be seen after some time of treatment, and patients with malignant tumors are not as pessimistic as you are. Patient: Hello Dr. Yu, thank you again! Last Friday I had a checkup at your place and learned that my nasal mucous membrane trauma is difficult to recover, so I feel very uncomfortable and pessimistic. When using the nasal spray you prescribed for me, I have a question, the instructions of this medicine is written once a day, each time to both sides of the nostrils two sprays, but at that time you told me to spray once in the morning and once at night, I do not know if this medicine will be sprayed too much bad, so I would like to ask whether I should follow the instructions to spray once a day, each time to both sides of the nostrils If I spray once a day according to the instructions and spray twice to each side of the nostrils, it will last about 140/4 = 35 days If I spray twice a day according to your instructions and spray twice to each side of the nostrils, it will last about 140/8 = 17 days =17 days How many times a day should I spray? And how many sprays should I give to each side of my nostrils? Thank you very much! Once again, I would like to express my sincere thanks to Dr. Yu!
Yu Hongmeng, Department of Otorhinolaryngology, Shanghai Five Gwangs Hospital: 2 times a day first, and then use it according to the instructions after a week.
I’ve been using saline to clean my nose for the past two days, and I’ve been using Neshu to spray my nose after cleaning it, and I’ve been eating the compound dahurica rhinitis granules prescribed to me by the doctor at my first visit to the Hospital of Five Officials. I’d like to ask, given that my nasal mucosa is very traumatized, is it possible to temporarily cure my rhinitis simplex like other people who use saline to wash their nasal passages? I don’t want to be completely cured, I just want to avoid this kind of nasal congestion forever. If surgery or something can cure it, I really want to operate right away. Dr. Yu has been answering questions for patients online every day, which really touched us.
Shanghai Five Gwangs Hospital ENT Department Yu Hongmeng: Take some time for treatment Patient: Hello, Dr. Yu. I’ve been on medication for a week, but I feel worse than before, I don’t know why? I first rinsed my nose with saline bought from the hospital and poured it directly into my hand. After rinsing for about 2 hours, I sprayed Nesuna. Now no matter day and night are nasal congestion, if walking outside to better, sitting down will definitely nasal congestion, two nostrils alternately plugged, what is the reason? I personally am rather ignorant, I read the manual of Nesuna, Nesuna is mainly for allergic rhinitis, and I have chronic simple rhinitis, I have 2 questions 1, is it because I use Nesuna has any side effects that cause nasal congestion during the day? 2. Is it possible that the chronic simple rhinitis will turn into allergic rhinitis after using Nesuna due to drug resistance or something? Thank you for answering our questions during your time off.
Yu Hongmeng, Department of Otorhinolaryngology, Shanghai Five Gwangs Hospital: I told you that the medicine you are using is not a vasoconstrictor and will not immediately ventilate the nasal cavity, but the vasoconstrictor will affect the function of the nasal mucosa. Now you use the drug has anti-inflammatory and anti-edema effect, need to use some time to see the effect.