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98例真菌球型鼻窦炎的临床特征及鼻声反射分析

[The clinical characters and acoustic rhinometry analyses of 98 cases fugal ball sinusitis].

作者信息

Yang Xu, Lei Ke

机构信息

Department of Otorhinolaryngology, Shanghai Xuhui Central Hospital, Shanghai, 200031, China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Sep;25(17):783-5.

Abstract

OBJECTIVE

To improve the cognition of fungal ball sinusitis (FB) for diagnosing and treatting it rightly, we retrospectively analyzed the hospitalization cases.

METHOD

We analyzed 98 cases FB patients' first symptom, acoustic rhinometry, CT manifestation, operation fashion.

RESULT

The first symptoms of FB include: 47.2% nosebleed, 38.8% snuffle, 28.6% headache and face-ache, 4.0% nasal peculiar smell, 2.0% excessive tear, 4.0% no symptom. Anterior nasoscope inspection include: 43.9% no significant abnormity, 13.3% nasoseptal deviation. 41.8% nasal cavity neoplasm (nasal polyp, nasoturbinal polyp, nasal meatus fugal ball etc), 25.5% secretion in nasal cavity. The parameters that conclude the nasal airway resistance (NAR), nasal cavity volume (NCV) and nasal minimal cross-section area (NMCA) have extremely difference (P<0.01) between FB and normal volunteers (NV): the NAR increase, but NCV and NMCA decrease; the Distance of the Minimal cross-sectional area from the nostril (DCAN) appear moving backword compared with NV. The CT manifestation: almost unilateral lesions, involved paranasal sinuses present asymmetric or symmetrical opacification: 60.2% with calcified area, 25.5% with local bone erosion, 74.5% with sinus wall sclerosis. 65.3% of the CT diagnoses as FB are accord with pathology diagnoses. The incidence of FB involve maxillary sinus most (54.1%), then sphenoid sinus (11.2%) and ethmoid sinus (5.1%), frontal sinus (2.0%), multi-sinus (32.7%). All cases operated functional endoscopy surgery: 13 cases with nasoseptal diorthosis, 4 cases with inferior meatus opening, 2 case with canine fossa opening; we clean up the fungal pathogen with different degree endoscope through different path.

CONCLUSION

The clinical symptom of FB is not representative; the acoustic rhinometry show that NAR increasing but NCV and NMCA decreasing maybe the reason of fungal infection; the CT examine is helpful for FB diagnosis; the functional endoscopy surgery is efficient therapy for FB.

摘要

目的

为提高对真菌球型鼻窦炎(FB)的认识,以便正确诊断和治疗,我们对住院病例进行了回顾性分析。

方法

分析98例FB患者的首发症状、鼻声反射、CT表现及手术方式。

结果

FB的首发症状包括:鼻出血占47.2%,鼻塞占38.8%,头痛和面部疼痛占28.6%,鼻腔异味占4.0%,流泪过多占2.0%,无症状占4.0%。前鼻镜检查结果为:无明显异常占43.9%,鼻中隔偏曲占13.3%,鼻腔肿物(鼻息肉、鼻丘息肉、鼻道真菌球等)占41.8%,鼻腔分泌物占25.5%。FB患者与正常志愿者(NV)相比,鼻气道阻力(NAR)、鼻腔容积(NCV)和鼻腔最小横截面积(NMCA)等参数有极显著差异(P<0.01):NAR增加,而NCV和NMCA减小;最小横截面积距鼻孔的距离(DCAN)与NV相比后移。CT表现:几乎均为单侧病变,受累鼻窦呈不对称或对称的混浊影:60.2%有钙化区,25.5%有局部骨质侵蚀,74.5%有鼻窦壁硬化。CT诊断为FB的病例中65.3%与病理诊断相符。FB累及上颌窦最多(54.1%),其次为蝶窦(11.2%)、筛窦(5.1%)、额窦(2.0%)、多鼻窦(32.7%)。所有病例均行功能性鼻内镜手术:13例行鼻中隔矫正术,4例行下鼻道开窗术,2例行犬齿窝开窗术;通过不同路径用不同程度的鼻内镜清理真菌病原体。

结论

FB临床症状不具代表性;鼻声反射显示NAR增加而NCV和NMCA减小可能是真菌感染的原因;CT检查有助于FB诊断;功能性鼻内镜手术是治疗FB的有效方法。

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