Atrophic rhinitis is a nasal disease that develops slowly and is characterized by atrophy of the nasal mucosa, periosteum and turbinates, loss of smell, and scab formation in the nasal cavity. This disease can be divided into two types: primary and secondary. The primary cause is unknown and may be related to genetic factors, malnutrition, metabolic disorders, endocrine disorders, etc. The secondary disease is mostly caused by local factors or multiple nasal surgeries. cause.
Atrophic rhinitis is a chronic rhinitis that develops slowly and is characterized by atrophy of the nasal mucosa, loss of smell, and scab formation in the nasal cavity. Its clinical manifestations include nasal congestion, dry nasopharynx, epistaxis, olfactory disturbance and foul odor, and may be accompanied by dizziness and headache. The cause of the disease is not yet clear, and there is currently no specific treatment in modern Western medicine.
Modern reports of acupuncture treating atrophic rhinitis began in the 1950s [1]. It was found that using warm needles gave better results. Later, clinical data continued to be published. In the 1970s, some people also tried the method of burying gut strings in acupoints to treat this disease [2]. In recent years, certain results have been achieved by exploring the sensitive points of the ear shell of atrophic rhinitis, using auricular acupuncture, and performing pulsed electric acupoint therapy. Of course, as of now, the treatment of this disease by acupuncture cannot be said to be fully mature, and it needs further accumulation of cases and deepening of understanding. However, in view of the difficulty in treating this disease, it is introduced in this section.
Treatment
Warm acupuncture
(1) Acupoint selection
Main acupoints: Zusanli, Sanyinjiao, Yingxiang.
Matching points: Heliao, Hegu, Bitong.
Bitong point location: at the upper end of the nasolabial fold, in the depression under the nasal bone.
(2) Treatment method
Take the main acupoints every time, and add 1 to 2 additional acupoints as appropriate. After acupuncture at Zusanli and Sanyinjiao to obtain Qi, place a 1-inch long moxa stick section on the needle handle, light it, and add two more sections after it is burned out. At the Yingxiang point, insert the needle diagonally, insert the needle to the Jiabi Tong point, twist and slightly lift and insert the needle, so that there will be an obvious sense of soreness and distension in the nasal cavity. For the remaining points, acupuncture is used to localize the Qi. Leave the needle in for 30 minutes. Once a day, every 20 times is a course of treatment. The intervals between treatments are 3 to 5 days.
(3) Efficacy evaluation
63 cases were treated, 2 cases were isolated cases, among the remaining 60 cases, 12 cases (20.0%) were basically cured, and 35 cases (58.3%) were effective. %), 13 cases (21.7%) were ineffective, and the total effective rate was 78.3%. Symptoms such as nasal congestion, crusts, headaches and epistaxis were found to be significantly improved [1, 3-5].
Embedding needles in ear acupoints
(1) Acupoint selection
Main acupoints: inner nose, endocrine.
(2) Treatment method
Take 1 acupoint at a time and carefully look for sensitive points. Then use a 0.5- to 1-inch long filiform needle, No. 26 to 30, to penetrate the sensitive point, directly to the perichondrium, about 1 to 2 minutes deep. After piercing, twist the needle clockwise several times to make the needle feel obvious, then fix it with tape, keep the needle on for 5 to 7 days (2 to 3 days in summer), and change the needle once. Each time the bilateral acupoints are used, the two main acupoints are rotated. 5 times constitute a course of treatment. The intervals between treatments are 10 days.
(3) Efficacy evaluation
22 cases were treated, 3 cases (13.6%) were markedly effective, 8 cases (36.4%) were effective, and 11 cases were ineffective (including 9 cases of discontinuation) )(50%), the total effectiveness is 50.0%[6].
Acupoint electrotherapy
(1) Acupoint selection
Main acupoint: Yingxiang.
(2) Treatment method
Use the meridian magnetic and electric therapy device (pulse electric group) for treatment. The output voltage of this instrument ranges from 0 to 600 volts in the high range and from 0 to 100 volts in the low range. It is controlled by the output regulator and the pulse frequency is 50 Hz. First, place two metal electrodes the size of coins on both sides of the Yingxiang points, with 10 layers of gauze wet pads underneath (the pads are slightly larger than the electrode pieces), and then turn the output knob until the patient feels current stimulation and twitching. , compression (such as massage), and ant walking sensation, the intensity should be tolerable to the patient. Apply electricity for 20 to 30 minutes, 1 to 2 times a day, 10 to 20 times is a course of treatment, and rest for 3 days between courses.
(3) Efficacy evaluation
Use this method to treat various chronic rhinitis (including simple rhinitis, allergic rhinitis, hypertrophic rhinitis and atrophic rhinitis, etc.)***1046 For example, the overall effectiveness rate is 90.8%. Among them, there were 13 cases of atrophic rhinitis, 1 case (7.7%) was basically cured, 2 cases (15.4%) were markedly effective, 3 cases (23.1%) were effective, and 7 cases (53.8%) were ineffective; the total effective rate was 46.2%. Compared with other types of chronic rhinitis, the efficacy is poor [7].
Acupoint implantation
(1) Acupoint selection
Main acupoint: Yingxiang.
(2) Treatment method
Take the main points from both sides, cut the straight part of the 3/0 catgut into 1cm and put it into a sterile tray for later use. Select the correct acupuncture point, perform routine disinfection, insert the cut catgut into the No. 11 lumbar puncture needle, align it with the acupoint, quickly pass through the subcutaneous tissue directly to the periosteum surface, lift it slightly, and wait until the patient feels swelling, numbness, etc., then insert the lumbar puncture needle The needle is slightly lifted away from the periosteum, and the catgut is gently pushed out and buried deep in the acupoint.
Then apply sterile dressing to the needle hole. Once every 3 weeks, 5 times constitute a course of treatment.
(3) Efficacy evaluation
Criteria for curative effect: recovery: nasal odor disappears, no scab, sense of smell improves, headache and nasal dryness disappear, nasal mucosa is ruddy, and turbinates are plump; Effective: Dry nose and throat are obviously better than before, there is occasional odor in the nasal cavity, there are a few pus scabs, and the mucosa is thicker and moister than before; Ineffective: After 2 courses of treatment, the symptoms are not improved.
40 cases were treated, 11 cases were markedly effective, 18 cases were effective, and 1 case was ineffective. The total effective rate was 96.7% [8].
References
[1] Zhang Wenbin. A report on the efficacy of acupuncture for atrophic rhinitis. Journal of Traditional Chinese Medicine 1958;(7):490.
[2] Otolaryngology Clinic of the Second Affiliated Hospital. Acupoint catgut embedding to treat atrophic rhinitis. New Medicine 1970; (Supplement 5): 7.
[3]Xu Yuan. The mechanism and efficacy of acupuncture in the treatment of atrophic rhinitis. Journal of Traditional Chinese Medicine 1960;(7):21.
[4]Zhu Gengyao. A report on the efficacy of acupuncture on 99 cases of otolaryngology diseases. Journal of Traditional Chinese Medicine 1959;(7):59.
[5]Deng Zecai, et al. Application of acupuncture therapy in otolaryngology. Jiangxi Traditional Chinese Medicine 1958;(10):22.
[6]Lin Shangze. Sensitive points of the auricle and auricular acupuncture treatment for atrophic rhinitis. Guizhou Medicine 1980;(3):42.
[7]Long Anmin. Observation on the efficacy of pulse electroacupuncture in the treatment of chronic rhinitis in 1046 cases. Chinese Acupuncture 1989;9(2):5.
[8]Wang Yanru, et al. 30 cases of atrophic rhinitis were treated by catgut embedding at Yingxiang point. Shandong Journal of Traditional Chinese Medicine 1998;17(1):23.
Clinical manifestations
1. Dryness of the nasal cavity and nasopharynx, nasal congestion, headache, foul-smelling breath, epistaxis, loss of smell, etc. 2. The nasal cavity is wide, the mucosa is dry and atrophic, the turbinates are shrunken, and there is a large amount of scab or thick purulent secretions.
Diagnostic basis
1. A long medical history, more common in young women, or a history of nasal trauma or multiple nasal surgeries. 2. Have the above symptoms and signs. 3. It should be differentiated from nasal tuberculosis, syphilis, leprosy and caseous rhinitis.
Treatment principles
1. Clean the nasal cavity, apply local softening scab, improve local circulation and use antibacterial drugs. 2. Use the drug throughout the body to dilate blood vessels, protect mucosal epithelium, and promote cell metabolism. 3. Surgical treatment, narrowing the nasal cavity, reducing intranasal ventilation and water evaporation to improve local symptoms.
Principles of Medication
1. General cases are mainly treated with local and systemic drugs, and the commonly used drugs are "A" + "B" drugs. 2. Patients with long course of disease, severe symptoms, and ineffective conservative treatment can be treated with surgery.
Auxiliary examination
1. General case examination is mainly based on the examination frame "A". 2. For those who have difficulty in diagnosis and need to make a differential diagnosis, the examination project may include examination frames "A", "B" or "A", "B", "C".
Effectiveness evaluation
1. Cure: No scab in the nasal cavity, moist mucosa, and symptoms disappear. 2. Improvement: nasal scabs are reduced and symptoms are improved. 3. Not healed: There are many scabs in the nasal cavity and the symptoms have not improved.
Expert Tips
The disease develops slowly, and because it is mostly primary and the cause is unknown, there is still no ideal treatment. Pay attention to removing scabs from the nasal cavity and insist on topical medication, which can improve symptoms and help control the development of the disease. Surgical treatment may be considered if local drug treatment is ineffective.
Symptoms
(1) Dryness in the nose and nasopharynx: This is due to the atrophy of the glands in the nasal mucosa and the decrease in secretions.
(2) Nasal obstruction: Nasal obstruction may be caused by pus scab blocking the nasal cavity, or because the nerve sensation of the nasal mucosa is dull, even if the pus scab is removed, it is not easy to detect the passage of air, which is mistaken for nasal obstruction.
(3) Nasal secretions: often in the form of lumpy or tube-shaped pus scab, which is difficult to blow out. When the dry scab is blown out with force, there will be a small amount of nose bleeding.
(4) Olfactory disorder: the sense of smell often decreases or disappears. This is caused by mucosal atrophy or dry scab obstruction in the olfactory area.
(5) Foul breath: Due to the proliferation and growth of bacteria under the pus scab, the protein in the pus scab is putrefied and decomposed, producing a foul odor, which is called stinky nose.
(6) Headache and dizziness: Due to the atrophy of the turbinates, the nasal cavity lacks temperature regulation and insulation, the inhalation of cold air irritates the nasal mucosa, and the stimulation of pus scab can cause headaches and dizziness.
Examination
(1) The nasal cavity is wide and the turbinates are reduced. The nasopharynx can be seen from the anterior nostril. Sometimes in secondary atrophic rhinitis, the inferior turbinate is significantly reduced, but the middle turbinate is not. Hypertrophy or polypoid changes.
(2) There is thick pus scab in the nasal cavity, which is yellow-brown or gray-green, large or tube-shaped, and may have a foul smell. After removing the pus scab, it can be seen that the turbinate mucosa is dry and atrophic, and even erodes and oozes blood. In early or mild atrophic rhinitis, there may only be scabs but no foul smell.
(3) If the atrophic lesions develop downward, the nasopharynx and pharyngeal mucosa may also dry and shrink, sometimes covered with pus and scab. In severe cases, the mucosa of the larynx and trachea may also undergo such changes.
Pay attention to the identification of nasal tuberculosis, lupus, sclerosis, rhinolith, leprosy, etc.
Treatment
(1) Clean the nasal cavity: Rinse the nasal cavity with 500-1000ml of warm saline or general warm saline to remove pus and scab to facilitate local administration. If the pus scab is difficult to remove, you can gently remove it with tweezers.
(2) Nasal medication: Commonly used lubricating nose drops, such as compound peppermint oil, liquid paraffin, 50% honey, clear cod liver oil, etc., can promote congestion and swelling of the nasal mucosa, increase blood circulation, and relieve nasal congestion. For internal dryness and odor, you can also use 1% streptomycin solution intranasally, which can inhibit the reproduction of bacteria, reduce inflammatory erosion, and facilitate epithelial growth. In addition, it lubricates the nasal mucosa and softens the scab, making it easier to blow it out.
(3) Vitamin therapy: I have tried multiple vitamins, usually intramuscular injection of vitamin A, 50,000 to 100,000 u per day, or oral vitamin B2, 10 to 15 mg, 3 times a day to protect the mucosa. Epithelium, promotes the metabolic function of tissue cells and enhances resistance to infection. You can also use 50,000 U of vitamin AD preparation intramuscularly, 2 to 3 times a week; or take cod liver oil pills orally, 2 pills, 3 times a day. Nicotinic acid can also be taken orally, 50 to 100 mg, 3 times a day. Some people have suggested that iron supplements can treat this disease. You can take ferrous sulfate pills, 0.3g, 3 times a day, after meals.
(4) Surgical therapy: It can be tried for those who are ineffective after long-term treatment. The purpose is to shrink the nasal cavity, reduce the amount of air inhaled, reduce water evaporation, reduce the formation of pus and scab, and stimulate the nasal mucosa to increase congestion and secretion, thereby improving symptoms.
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