开放性喉损伤的急救处理

目的讨论和总结开放性喉外伤的临床表现和急救处理，提高开放性喉外伤的急救处理水平。方法报告开放性喉外伤38例。对开放性喉外伤的临床表现、紧急抢救、治疗及疗效做了详细的讨论。结果38例均抢救成功，抢救成功率100％，37例患者顺利拔除气管套管，4例遗留声嘶；1例因喉狭窄而带管需二期手术治疗。结论开放性喉外伤常有呼吸道梗阻或合并大出血，随时可危及患者生命，急救处理要及时。首先要保持呼吸道通畅，仔细检查创面，彻底止血，细心修复创面、尽量保持喉的结构和功能，否则处理不当可危及患者生命或遗留喉瘢痕狭窄等并发症。     

手术治疗喉气管狭窄──60例复习

喉气管狭窄（ＬＴＳ）是耳鼻咽喉科医师面临的重要难题之一，其主要发生原因是气道损伤，常见于气管插管、颈部外伤及气管切开术后，成功的治疗有赖于准确的诊断。诊断包括确定阻塞的部位、长度、程度及相关的复合病变如声带麻痹、气管软化和气管食管瘘。病变简单者的治疗方法包括喉内类固醇注射、喉内扩张及内窥镜下清除喉内阻塞，病变复杂者须行手术治疗。本文报道２０年间手术治疗６０例ＬＴＳ的体会。男３９例，女２１例，因气管插管时间过长或损伤所致者２５例，气管切开术后２１例，外伤后９例，自发性４例，气管软化１例；单纯声门下…     

外伤后喉-气管狭窄合并喉-气管断裂、环状软骨骨折及喉返神经拉长

近年来外伤后喉-气管狭窄合并其他喉部损伤较多见。合并于喉外伤的常见损伤有:①喉气管在环状软骨下缘断裂,气管回缩到纵隔内;②喉返神经拉长或拉断;③环状软骨骨折;④喉粘膜回缩致环状软骨裸露。患者外伤后将立即出现呼吸困难,声音嘶哑,如颈部有擦伤及皮下气肿提示呼吸道有损伤,内腔镜检查可确诊。如喉返神经麻痹或呼吸道管腔塌陷,可导致呼吸道急性阻塞;出血亦可引起急速或缓慢的窒息。经姑息疗法(气管切开术,或最好先采用喉-气管插管术)后,病人存活,则可发生炎性纤维性狭窄。喉损伤的手术治疗,可按下列原则进行: 1.缝合喉-气管断裂处:一般很容易将向下     

避免气管切开的喉裂开术

避免气管切开的喉裂开术周晓红１杨森１喉裂开术是治疗喉部疾病的一种手术进路，一般用于病变范围小的喉内病变，通常该手术是先行气管切开后做喉裂开术，以防术后发生呼吸道梗阻。我院曾遇４例病变范围小的患者在局麻下行喉裂开术，未行气管切开，术后无１例发生喉梗阻...     

神经性肌强直症并发喉阻塞临床分析（附1例报告）

目的 探讨神经性肌强直症并发急性喉阻塞的诊断及治疗，并结合文献对此病的病因、发病机制、临床表现及诊治进行复习。方法 回顾性分析我科2000年收治的l例神经性肌强直症并发喉阻塞患者的诊治情况。结果 应用苯妥英钠加气管切开可以防治本病。结论 喉阻塞常首诊于耳鼻咽喉一头颈外科，而以神经性肌强直症并发者易造成误诊或误治，因此，保持病人呼吸道通畅，急诊行气管切开是必要的。     

喉气管成形术

新生儿和婴儿由于喉、气管病变造成的呼吸道阻塞,在诊断和治疗上还存在着许多问题,自开展喉部显微手术以来,已有几项新的手术用来解除喉及气管上部狭窄,设计的手术方案要尽量少影响喉的成长并保存其纤毛上皮层的功能。作者从1969至1974年五年间遇及喘鸣儿童427例,经直接喉镜检查,所见病因分析如下:     

喉硬结病的临床特点与治疗

目的探讨喉硬结病的临床特点和治疗方法。方法回顾性分析1981年5月～2002年12月收治的43例经病理证实的喉硬结病患者的临床资料和治疗方法。结果43例中声嘶43例次、呼吸困难19例次。喉部病变以萎缩期为主2例，肉芽肿期为主35例，瘢痕期为主6例。主要病变局限于声门区13例，局限于声门下区1例；累及声门上区和声门区18例，累及声门区和声门下区8例，声门上区、声门区和声门下区均受累3例。采用抗生素治疗24例，手术治疗7例，放射治疗2例。采用抗生素治疗24例中，18例治愈，另2例复发后再进行抗生素治疗治愈；24例中4例伴2度或3度喉阻塞者行预防性气管切开术。1例伴2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。6例伴喉狭窄的瘢痕期患者通过手术成形治愈。1例采用放射治疗后4年复发，1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论硬结病可侵犯喉部导致发声困难和喉阻塞，抗生素治疗对多数喉硬结病患者有效，治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

不做气管切开的喉裂开术

喉裂开术是治疗喉部疾病的一种手术进路。通常在正中切开甲状软骨后对喉内病变进行一些简单操作，如对T2声门型喉癌做声带切除术等。历史上这一手术是否一开始就与气管切开一起做没有考证过，但耳鼻咽喉科医生已习惯地认为气管切开是一种防止喉裂开术后引起呼吸道梗阻的常规方法。因此，科教书上均写着：“气管切开后再做喉裂开术”。     

气管切开手术观念的变迁

气管切开手术观念的变迁宋国平气管切开术最早仅用于喉阻塞引起的呼吸困难，但近年来，因下呼吸道及中枢性病理因素所行气管切开已大大超过了上呼吸道阻塞因素。因而，有必要重新认识气管切开术的意义。近１０年来，我院行气管切开术２９０例，现对其。临床资料进行分析，...     

改良气管切开术在吸入性损伤抢救中的应用

目的探讨治疗重度吸入性损伤患者下呼吸道黏膜大面积坏死及清除脓血痂的有效方法.方法应用改良气管切开术抢救治疗重度吸入性损伤12例.常规气管切开暴露颈段气管3～5环,以颈4环为中心,上下弧形切除少许气管软骨,长度不超出2个气管环,分别缝合同侧的皮肤与气管切口1～2针,插入气管套管.结果改良气管切开术可随时取管,方便纤维支气管镜检查,及时清除下呼吸道阻塞物,预防发生再窒息,12例患者无1例因呼吸道阻塞而死亡.结论改良气管切开术不仅解除了喉梗阻,而且可观察下呼吸道病变及能有效、安全的清除阻塞物.     

Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry.

The aim of this study was to evaluate the improvement of nasal flow and the fall of nasal resistance in 50 patients that underwent rhinoseptoplasty in our department and discuss the relative importance of valvular and septal deformities in nasal airway obstruction. Fifty consecutive patients underwent rhinoseptoplasty to improve nasal obstruction caused by severe septal deviation, external or internal valvular incompetence, or any combination of the three. We excluded patients with minor septal curvatures, septal perforations, or turbinate hypertrophy. Preoperative and postoperative rhinomanometry was performed on all 50 patients. In all 50 patients, septal and/or valvular surgery lowered nasal resistance in 90% of cases. Septoplasty alone with medial and basal osteotomies did not improve nasal flow (p < 0.4), whereas the correction of valvular obstruction alone increased nasal airflow in a statistically significant way (p < 0.0001). Moreover, patients with both valvular incompetence and septal deviation represented the group in which the greatest preoperative obstruction and the greatest postoperative improvement occurred. Nasal valvular function should be assessed with rhinomanometry in all preoperative rhinoplasty patients with airway obstruction. In many cases, valvular effects may surpass septal deviation as the primary cause of nasal airflow obstruction.     

Nasal valve surgery improves disease-specific quality of life

OBJECTIVES/HYPOTHESIS: Disease-specific quality-of-life (QOL) assessment of patients with nasal valve compromise and symptomatic nasal obstruction has not been studied previously. The objectives of the study were to determine whether surgical treatment of the nasal valve improves disease-specific QOL and to identify clinical or demographic variables predictive of patients' baseline QOL or change in QOL. STUDY DESIGN: Prospective, multi-institutional outcomes study of 20 patients with nasal obstruction and a surgically treatable diagnosis of nasal valve compromise. METHODS: Disease-specific QOL assessment was performed using the Nasal Obstruction Symptom Evaluation (NOSE) scale preoperatively (n = 20) and at 3 (n = 14) and 6 months (n = 20) after surgery. Clinical and demographic data were collected, along with physician-reported assessments of degree of nasal obstruction. RESULTS: Mean NOSE scores significantly improved from baseline to 3 months after surgery (68.9 vs. 20.7 [P < .0001]), from baseline to 6 months after surgery (68.9 vs. 15.8 [P < .0001]), and from 3 to 6 months after surgery (20.7 vs. 15.8 [P = .0077]). Physician assessment of degree of nasal obstruction using a visual analogue scale was significantly correlated with baseline NOSE scores (P = .013) and change in NOSE scores at 6 months (P = .0015). No other clinical or demographic factors were found to be predictive. CONCLUSION: In patients with symptomatic nasal obstruction and nasal valve compromise, surgical repair of the nasal valve improves disease-specific QOL. Physician rating of degree of nasal obstruction was found to be significantly correlated with patient-reported QOL.     

Quality of life assessment in nasal airway obstruction

OBJECTIVES/HYPOTHESIS: Quality of life (QOL) assessment of patients with nasal obstruction has not been well studied. The objectives of the study were to determine the QOL of patients with nasal obstruction, to identify baseline variables predictive of patients' QOL, and to examine the relationship of QOL scores with patient assessment of nasal obstruction. STUDY DESIGN: Preliminary, cross-sectional study of a larger, prospective investigation. METHODS: Forty individuals met the criteria for inclusion. Participants were required to have a surgically treatable diagnosis of septal deviation, nasal valve collapse, and/or turbinate hypertrophy. Quality of life assessment was performed using the Rhinoconjunctivitis Quality of Life Questionnaire and the Rhinosinusitis Disability Index. Demographic data, along with patient assessment of nasal obstruction with a visual analogue scale, were recorded. RESULTS: Both instruments demonstrated good inter-item correlation as measured by Cronbach's alpha. Demographic variables, previous nasal surgeries, and comorbid conditions were not significantly correlated with QOL scores with either instrument. Correlations between visual analogue scale scores and the Rhinoconjunctivitis Quality of Life Questionnaire "sleep" (correlation coefficient [r] = 0.35, P =.02) and "nasal symptom" (r = 0.36, P =.02) domains demonstrated a trend toward significance. Patients with nasal valve collapse reported higher visual analogue scale scores for nasal obstruction compared with those with septal deviation alone (P <.01). CONCLUSIONS: Patients with nasal valve collapse demonstrated greater perception of nasal obstruction than those with septal deviation alone. The Rhinoconjunctivitis Quality of Life Questionnaire appears to be a more sensitive instrument than the Rhinosinusitis Disability Index for patients with nasal obstruction. However, existing measures may lack sensitivity in estimating the QOL of patients with nasal obstruction. A disease-specific instrument for nasal obstruction may be necessary to further evaluate this disease process.     

鼻腔扩容术对鼻塞伴OSAHS患者的主客观症状的影响

目的探讨鼻腔扩容术对伴有鼻塞的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主客观症状的影响,为鼻腔扩容术对鼻塞伴OSAHS的患者治疗提供有效的临床依据。方法选择69例伴有鼻塞的OSAHS患者,针对病变的鼻中隔、下鼻甲、中鼻甲、钩突、筛泡等不同部位的病变进行个体化的处理。根据呼吸暂停低通气指数(AHI)及最低动脉血氧饱和度(LSaO2)分为三组:轻度、中度与重度组。通过比较患者手术前后多导睡眠检测(PSG)结果及鼻塞视觉模拟评分量表(VAS)、Epworth嗜睡量表(ESS)、患者鼾声问卷(SS)评分,分析鼻腔扩容术对鼻塞伴OSAHS患者的主客观症状的影响。结果术后6个月随访显示,其中轻度OSAHS患者的AHI、LSaO2及平均动脉氧饱和度(MSaO2)有所升高(P<0.05),VAS、ESS及SS评分都有所降低(P<0.05)。中度OSAHS患者的PSG相关检测指标均无明显变化(P>0.05),VAS、ESS及SS评分有所降低(P均<0.05)。重度患者除VAS及ESS评分有所降低(P<0.05),PSG相关客观指标及SS评分均无明显变化(P>O.05)。结论鼻腔扩容手术可以改善鼻塞为主的OSAHS患者的鼻塞、睡眠打鼾及白天嗜睡等主观症状,对轻度OSAHS患者的疗效优于中重度OSAHS。对鼻塞伴OSAHS患者的治疗有重要的临床意义。     

Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing

Objectives

We wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality.

Methods

Polysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed.

Results

Significant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index, the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction.

Conclusion

The severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.     

A randomised clinical trial of turbinectomy for compensatory turbinate hypertrophy in patients with anterior septal deviations

Turbinectomy is performed at the time of nasal septal surgery by many otolaryngologists. One reason given for this procedure is the presence of a hypertrophied contralateral inferior turbinate. A randomised trial was undertaken to evaluate the relief of nasal obstruction following contralateral turbinectomy with septal surgery. Patients presenting with nasal obstruction who had a unilateral septal deviation and contralateral inferior turbinate enlargement were prospectively randomized to contralateral turbinectomy or no turbinate surgery at the time of septal surgery. Questionnaires and active anterior rhinomanometry were used for evaluation. Twenty-six patients (mean age 31 years) demonstrated a reduction in subjective and objective measures of nasal obstruction (P < 0.05) 8 weeks after operation. There was no intergroup difference, the median total decongested nasal resistance postoperatively in the non-turbinectomized patients was 0.17 kPal-1 s and 0.21 kPal-1 s in the turbinectomized patients. Contralateral inferior turbinectomy does not add to the relief of nasal obstruction beyond that attained by septal surgery in these patients.     

Role of the External Nasal Dilator in the Management of Nasal Obstruction

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross-sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.     

Clinical indication of nasal surgery for the CPAP intolerance in obstructive sleep apnea with nasal obstruction

ObjectiveThe role of isolated nasal surgery for obstructive sleep apnea (OSA) patients with nasal obstruction, especially for an intolerance for continuous positive airway pressure (CPAP), is unclear. The aim of this study was to assess the effects of surgery for OSA patients with symptomatic nasal obstruction and CPAP intolerance.MethodRetrospectve comparative study.1037 OSA patients with apnea-hypopnea index (AHI) ≥ 20 were enrolled. Case-control study was performed between the male apnea patients undergoing nasal surgery: surgery group (n = 43) and the pair-matched apnea patients for age, sex, body mass index, and race: control group (n = 43). The surgery group suffering from nasal obstruction could not use continuous positive airway pressure, and the CPAP group free from nasal obstruction could use it successfully.ResultsIn surgery group, surgery significantly decreased the nasal resistance and Epworth sleepiness scale scores without changing the AHI. Surgery significantly increased the nadir of oxygen saturation and shortened the apnea-hypopnea duration. Although all of the surgery group failed to use positive airway pressure preoperatively, the 40 patients of the 43 CPAP intolerance patients were able to use CPAP postoperatively. The resting three patients were cured OSA or changed the treatment to oral appliance(OA). For both groups, the cutoff nasal resistance for differentiating the failure of positive airway pressure and its success was 0.31 Pa/cm³/s.ConclusionIsolated nasal surgery is effective for an intolerance of positive airway pressure in sleep apnea with nasal obstruction presumably by decreasing nasal resistance.     

Assessment of early- and late-phase nasal obstruction in atopic patients after nasal allergen challenge*

In order to study the types of nasal obstruction in allergic rhinitis, nasal allergen challenge was performed in 18 atopic patients, compared with a control group consisting of 10 healthy volunteers. Passive anterior rhinomanometry was used as an objective evaluation of nasal airway resistance. A 100% increase of nasal airway resistance was considered to be a positive reaction. In the control group, no obvious nasal obstruction was recorded after nasal phosphate buffered saline challenge. In the patient group, nasal obstruction occurred only after challenge in 94% during the early phase and in 82% during the late phase. During the late-phase four major types of nasal obstruction were found, i.e. no nasal obstruction; onesided nasal obstruction only; bilateral nasal obstruction; and alternating nasal obstruction. Of the four types, the alternating type was the most common (47%) type, especially during the late-phase.     

Posture-induced nasal obstruction in patients with allergic rhinitis

Nasal resistance is affected by posture. In this study, the effects of supine and lateral recumbent positions were investigated in eight normal subjects and 31 patients with allergic rhinitis. Of the 31 patients with allergic rhinitis, five showed unilateral complete nasal obstruction and one patient showed bilateral complete obstruction during the change of posture. Total nasal resistance had a tendency to increase with repeating the change of posture (a paired t-test, P < 0.05). The supine and lateral recumbent positions did not induce variable changes in total nasal resistance in normal subjects. Posture induces complete nasal obstruction in the supine or lateral recumbent positions in some patients with allergic rhinitis.