Ozena (fetid cold) — the progressing atrophic process happening in a mucous membrane, cartilaginous and bone structures of a nose and which is followed by allocation of the viscous secret which is drying up in crusts with an unpleasant smell. Clinically the ozena is shown to constants by the viscous separated from a nose, putrefactive smell of allocations, existence in a nose of plentiful crusts, loss of sense of smell and other symptoms. From diagnostic testings at the ozena the rinoskopiya, a faringoskopiya, KT and a X-ray analysis, a bacteriological research of nasal allocations are applied. In treatment of an ozena are used as medicamentous (antibiotic treatment, washings and instillations of a nasal cavity, physiotherapeutic procedure), and surgical (movement of sidewalls of a nose, implantation hallo - gomo-and autografts, replanting of an ivalon, etc.) methods.
Ozena is known to medicine since ancient times. The description of symptoms of this disease occurs in manuscripts of the Egyptians and Hindus written for 1000 BC. Now the ozena meets quite seldom and makes 1-3% of all diseases of a nose and okolonosovy bosoms. People up to 40-50 years get sick generally, it is the most frequent — children. At women of an ozen it is observed more often than at men. Ozena cases were never noted among mulattos, representatives of negroid race and Arabs.
According to clinical observations the modern otolaryngology allocates the following trigger factors leading to development of an ozena: covered injuries of a nose and bones of a facial skeleton, damage - palatal knot, vegetative nervous trunks and a trigeminal nerve, various infectious diseases (a rubella, scarlet fever, measles, diphtheria, chicken pox), the chronic infectious centers (chronic rhinitis, adenoidit, tonsillitis, sinusitis, pharyngitis), bad social conditions, addictions, violations in food.
Causes of an ozena
In spite of the fact that the ozena is very ancient disease, its exact etiology is not called yet. Today there is a set of the theories which appeared as a result of continuous attempts of scientists to find the causes of an ozena.
The so-called anatomic theory says that the ozena is connected with width of the nasal courses increased from the birth, excessively wide facial skull and an underdevelopment of additional bosoms of a nose. The pathophysiological theory assumes that the ozena is result of the postponed inflammatory processes in a nose cavity. The infectious theory is based that at patients from ozeny a large number of various microflora is sowed. The uniform activator of an ozena is not revealed yet, however approximately at 80% of the diseased in a bakposeva the klebsiyella of an ozena is defined. According to the focal theory of an ozen arises as a result of changes in okolonosovy bosoms that is confirmed by presence at many patients ozeny slow chronic sinusitis.
Also hereditary theory of an ozena, factual family cases is known. She speaks not about direct inheritance of an ozena, and about genetic predisposition to it against the background of which various trigger factors lead to development of a disease. The neurogenetic theory betrays paramount value in pathogenesis of an ozena to violation of a vegetative innervation owing to dysfunction of parasympathetic and sympathetic nervous system. The basis of the endocrine theory of emergence of an ozena was formed by the features of a course of this disease at women which are characterized by change of expressiveness of symptoms during hormonal reorganizations (periods, pregnancy, a climax).
Manifestations of an ozena
The ozena passes 3 consecutive stages in the current: initial, a heat and finishing, each of which is characterized by the features.
The initial stage of an ozena in most cases arises at the age of 7-8 years. The disease begins imperceptibly and develops gradually. After a while from the beginning of an ozena parents of the child pay attention that it almost constantly observes allocations from a nose. Separated initially has a viscous consistence, over time gets an unpleasant smell and becomes purulent. At the patient ozeny the child headaches, increased fatigue, sleep disorders, weakness, a loss of appetite can be noted from time to time.
The initial stage of an ozena differs in the persistent progressing current which any of the existing treatment methods can almost not stop. As a result of development of a disease in a nose crusts, a smell separated from a nose begin to be formed to become putrefactive and is well felt by surrounding people. The unpleasant smell proceeding from the child's nose with ozeny amplifies in the pubertatny period even more. At the same time the patient ozeny gradually ceases to feel this smell that is connected with damage of olfactory receptors of a cavity of a nose and emergence of a gipoosmiya.
The stage of a heat of an ozena has the expressed clinical picture. In this stage of an ozena patients note existence of a large number of plokhoudalyaemy crusts in a nose, difficulty of nasal breath, constant allocations from a nose of a viscous consistence, a congestion and dryness of a nose, total absence of sense of smell, decrease in flavoring sensitivity, pain in a forehead and a pyramid of a nose, a bad dream, increased fatigue and slackness. At the ozena nasal bleedings are possible.
Survey of the patient with ozeny, as a rule, reveals signs of an underdevelopment of a facial skull and in particular nose pyramids, reinforced lips, wide nostrils and the expanded nasal courses. Discrepancy of the wide nasal courses to complaints of the patient, typical for an ozena, to difficulty of nasal breath is observed that is explained by decrease in sensitivity of tactile receptors which normal perceive air circulation in a nose cavity.
The finishing (terminal) stage of an ozena usually arises not earlier than 40-year age. In this stage there is a termination of formation of crusts in a nose, reduction and total disappearance of allocations and the related unpleasant smell. The closing stage of an ozena is considered spontaneous treatment of a disease. However the happened atrophic changes of structures of a nose lead to permanent preservation after the postponed ozena of symptoms of chronic atrophic rhinitis: dryness in a nose and an anosmiya.
Atypical forms of an ozena
The unilateral ozena arises at patients with a considerable curvature of a nasal partition from which expansion of one half of a nose and narrowing another results. The unilateral ozena has a current, characteristic of a classical ozena, but develops only in wider half of a nose.
The localized ozena occupies only limited sites of a cavity of a nose. Most often the average nasal courses are surprised. Often at the localized ozena the atrophy only of back pieces of the average nasal courses while in their forward departments the hypertrophy is noted is observed.
Ozena without crusts is not followed by viscous allocations, existence of crusts and an unpleasant smell. At the same time all other signs of an ozena which can be shown in various degree take place.
Treat local complications of an ozena: ozeozny laryngitis, ozeozny pharyngitis, laryngotracheitis, chronic sinusitis (plays the dandy, antritis, etmoidit, it is extremely rare — sfenoidit), inflammatory processes of an eyeball (conjunctivitis, blefarit, dakriotsistit, keratit) and fish soup (chronic average otitis, evstakhiit).
Can be the remote complications of an ozena: bronchitis, pneumonia, neuralgia of a trigeminal nerve, kraniotsefalny syndromes, meningitis. Due to the long constant proglatyvaniye of the pus which is emitted at the ozena there can be complications from digestive tract: dyspepsia, gastritis, locks, meteorizm. Psikhastenichesky complications of an ozena are possible: decrease in memory, depression, intellectual apathy, neurasthenia and so forth.
Diagnostics of an ozena
In an initial stage diagnostics of an ozena is very difficult, especially at children who it is often long are treated at the otolaryngologist with the diagnosis "chronic rhinitis". In a heat stage the characteristic clinical picture of a disease and results of endoscopic researches do not leave doubts in presence at the patient of an ozena. Rinoskopiya reveals the expanded nasal courses; atrophy mucous, nasal sinks and Joán; the crusts which are densely covering mucous having yellowish-green or dirty-gray color. During removal of crusts under them the pale, extremely thinned, but not bleeding mucous membrane of a nose is visible. Considerable expansion of the nasal courses at patients from ozeny leads to the fact that through them the back wall of a throat, an entrance to a wedge-shaped bosom, the movements of a soft palate is visible during the conversation or swallowing.
The microscopy mucous a nose at the ozena reveals a metaplaziya of its cylindrical resnitchaty epithelium in orogovevayushchy flat. Distribution of the atrophic process which is the cornerstone of an ozena to a throat leads to the fact that during a faringoskopiya atrophic changes of a back wall of a throat, and also symptoms of atrophic laryngitis are defined.
The X-ray analysis of a skull and okolonosovy bosoms at patients from ozeny defines atrophic processes in bone structures of a nose and in walls of bosoms: a lacunary rassasyvaniye and thinning of bone beams with replacement of a bone tissue by fibrous. The same changes are observed on KT of a skull and okolonosovy bosoms. For verification of the activators which are in a cavity of a nose to patients with ozeny appoint a bacteriological research of allocations and dabs from a nose and a pharynx.
Treatment of an ozena
Lack of exact data on an etiology of an ozena and a variety of theories of its emergence led to emergence of various techniques of its treatment. In clinical practice both medicamentous, and surgical ways found the application. Drug treatment of an ozena includes the general therapy and local medical procedures. The general therapy of an ozena comes down to performing rational antibiotic treatment by medicines to which according to an antibiotikogramma the klebsiyella of an ozena is sensitive.
Local treatment of an ozena is performed by regular washings of a cavity of a nose of 0,9% chloride sodium solution, disinfecting and alkaline solutions. For the purpose of the best removal of the crusts which are available in a nose before such washing carry out plugging of a cavity of a nose turundy with proteolytic enzymes. After removal of allocations and crusts from a nose make endonasal instillations and a mortgaging of ointments. For this purpose use weak solution of nitrate of silver, the vitaminized oils, Lugol solution, sea-buckthorn oil, oil solutions of vitamins E and A. V local treatment of an ozena also apply physiotherapeutic methods: Ural federal district, laser therapy, electrophoresis of solutions of potassium of iodide, chymotrypsin, nicotinic acid.
In surgical treatment of an ozena there are several techniques. Because the ozena arises in the wide nasal courses, the methods directed to reduction of width of the nasal courses were developed. Operations on movement of sidewalls of a nose, implantation under a mucous membrane of walls and a partition of a nose of an alloplast (is more often than vaseline or paraffin), implantation of acrylic sticks or balls, change gomo-and autografts concern to them.
In treatment of an ozena stimulation methods traffic mucous a nose found the application. One of them is replanting of an ivalon to the area of back department of a nasal partition where the vegetative nervous texture on which it carries out the stimulating influence settles down.
The methods of treatment of an ozena promoting additional moistening mucous a nose are applied. The method Almeyda consists in creation of a drainage opening in a plaintive bag on which the tear comes to the average nasal course. The method of treatment of an ozena on Vitmaaka consists in a podshivaniye of a channel of parotid gland in a cavity of a maxillary bosom from where its secret gets to the average nasal course.