Disorders of the Nose and Sinuses

 

The upper part of the nose consists of bone and the lower part of cartilage. Inside is a hollow cav­ity (nasal cavity) divided into two passages by the nasal septum. The bones of the face contain sinuses, which are hollow cavities that open into the nasal cavity.

Because of its prominent position, the nose is particularly vulnerable to injury. In addition, dis­orders such as infections, nosebleeds, and polyps affect the nose. The sinuses may become infected, resulting in inflammation (sinusitis).

Text A. Fractures of the Nose

 

The bones of the nose are broken (fractured) more frequently than other bones of the face. When nasal bones break, the mucous membrane lining the nose usually tears, resulting in a nose­bleed. Because the mucous membrane and other soft tissues swell quickly, the break may be diffi­cult to find. Most commonly, the bridge of the nose is pushed to one side, with the nasal bones pushed in on the other side. If blood collects in the cartilage of the nasal septum (the structure that divides the nose), the cartilage may become infected and die, resulting in a saddle deformity, in which the bridge of the nose sags in the middle.

Diagnosis and Treatment

A person whose nose bleeds and hurts after a blunt injury may have a broken nose. Ordinarily, a doctor diagnoses a broken nose by gently feeling the bridge of the nose for irregularities in shape, unusual movement of bones, the rough sensation of broken bones moving against one another, and tenderness. The diagnosis is con­firmed with x-rays.

When a broken nose is set, adults are usually given a local anesthetic, and children a general anesthetic. Blood that has collected in the septum is drained to prevent infection and loss of carti­lage. After the nose is manipulated into its normal position, it's stabilized with gauze packing inside and splinting outside. Fractures of the septum are difficult to set and often require surgery later.

Notes:

bridge of nose переносица

sag провисать, обвисать, прогибаться

drained дренированный

gauze марля

 

Text B. Nosebleeds

 

Nosebleeds (epistaxis) have a variety of causes. Most often, the blood comes from Kiesselbach's area, which is located in the front part of the nasal septum and contains many blood ves­sels.

Causes of Nosebleeds Localized infections Vestibulitis Sinusitis Dried mucous membrane in the nose Injury Repeated injury from picking the nose · Fracture of the nose Narrowing of the arteries (arteriosclerosis) High blood pressure Disorders causing a tendency to bleed Aplastic anemia Leukemia Low platelet count (thrombocytopenia) Liver disease Hereditary blood disorders such as hemophilia · Hereditary hemorrhagic telangiectasia

Bleeding usually can be controlled by pinching the sides of the nose together for 5 to 10 minutes. If this technique doesn't stop the bleed­ing, a doctor looks for the source of the bleeding. Bleeding can be stopped temporarily by applying pressure inside the nose with a piece of cotton wool saturated with a drug that causes blood ves­sels to constrict, such as phenylephrine, and a local anesthetic, such as lidocaine. After the bleeding has stopped and the site is numb, the doctor seals (cauterizes) the bleeding source with silver nitrate or electrocautery (a device that uses an electric current to produce heat).

If a person has a disorder causing a tendency to bleed, the bleeding source isn't cauterized because it might begin to bleed again. Instead, a doctor gently presses gauze saturated with petro­leum jelly against the bleeding source. After the bleeding has stopped, the doctor tries to identify and correct the disorder.

In people who have narrowing of the arteries (arteriosclerosis) and high blood pressure, the bleeding source is likely to be further back in the nose, where bleeding is more difficult to stop.

Sometimes a doctor must close off (ligate) the artery supplying blood to the area or pack the back of the nasal cavity with gauze. Usually, the packing is left in place for 4 days, and an antibiotic such as ampicillin is given by mouth to prevent an infection of the sinuses or middle ear.

People who have hereditary hemorrhagic telangiectasia (a disease in which blood vessels are malformed) may have many severe nosebleeds, resulting in severe, persistent anemia that isn’t easily corrected with iron supplements. A skin graft onto the nasal septum reduces the number of nosebleeds so that the anemia can be corrected.

People who have extensive liver disease, which can result in a tendency to bleed often, have se­vere nosebleeds. Large amounts of blood may be swallowed and broken down into ammonia by bacteria in the intestine. Ammonia can be absorbed into the bloodstream and can make a person sick or become comatose, so enemas and cathartics are given to remove the blood from the intestine as soon as possible. In addition, an antibiotic such as neomycin is given to prevent the breakdown of blood into ammonia. If a large amount of blood is lost, a blood transfusion may be given.

Notes:

narrowing сужение, уменьшение

supplement добавление, дополнение; приложение

graft лоскут, трансплантат