空鼻症候群

title: 主要症状.
content: 空鼻症的两大症状为: 其他主要症状还包括睡眠困难和长期疲倦。因为这些慢性症状,所以患者的生活质量会大大降低,并会难以专注、产生焦虑及忧郁。另外可能出现的并发症还包括哮喘和慢性阻塞性肺病。
title: 病因.
content: 鼻腔中的鼻甲有着增润、调节温度、过滤空气、控制气流和感应气流等作用。气流进入鼻腔后,会绕过鼻甲,其结构有效提高空气与鼻粘膜的接触面积。鼻甲的功用对鼻部健康极为重要。其结构呈流线体,在处理空气的同时并不阻碍气流。  鼻甲能够保护内鼻粘膜,帮助其休息及再生。正常的成年人鼻腔能够在24小时内处理1万升空气,因此鼻粘膜需要有一定的休息期,才可保证呼吸道上皮的健康。这种间断的休息期称为鼻周期。每3至6小时,血液充盈半边鼻,使其休息和再生;另外一边则不被充盈,进行大部分的呼吸工作。在下鼻甲切除后,鼻周期无法使血液完全充盈受损的一边,因此丧失自然再生的能力。  人类的鼻子一般有三对鼻甲:下鼻甲、中鼻甲和上鼻甲。每一对鼻甲的大小和形状都非常不同,有着各自保护的鼻腔空间。下鼻甲最大,几乎占据整个鼻腔下部,从前部一直延伸到接近鼻咽处。由于下鼻甲处理大部分被吸入的空气,所以一旦被损坏,会对剩余的粘膜有极大的影响。中鼻甲位于下鼻甲之上,大约在鼻腔中部。中鼻甲相对较小,含有嗅觉神经轴突,且保护鼻腔上部,特别是位于顶部的嗅觉神经束以及筛窦和前额窦部分。中鼻甲的损坏对温度、湿度的调节影响不大,但可能会降低嗅觉并影响筛窦和前额窦的健康。上鼻甲最小,是保护嗅球的最后一道防线。  如果损失过多的鼻甲组织,被切除部位周围剩余的粘膜会逐渐发炎、变干、化生,并最终萎缩。鼻子的四大功能将会受到损害:呼吸、防御、嗅觉和产生音韵。这一过程可以持续若干年,使得早期诊断非常困难。患者一般在鼻甲切除术后不久就能感觉到空鼻症的症状。
title: 诊断.
content: 空鼻症的先兆包括:患者感到用鼻子呼吸困难,并有强烈的窒息感、鼻腔干燥感。这些征兆只在鼻甲切除术之后出现,有时甚至在几年后才出现。  患者的鼻腔空间异常大,部分鼻甲丧失。某些患者的鼻粘膜因化生而干燥,其他患者则有呈红色的慢性发炎粘膜。硬化情况各异。由于干燥和过强的气流,剩余的组织很有可能有过度萎缩的情况。
title: 预测.
content: 有关空鼻症候群的长时间观察和研究很少。因为鼻甲切除术后的继发性病症,所以空鼻症多年来都没有受到正确的判断。比如,剩余的粘膜组织(鼻中隔以及其余的鼻甲)通常会极度萎缩,造成实际的阻塞。  由于缺乏长时间观察,因此目前还没有数据显示多少百分比病患者的症状会迅速或大幅度的好转。该病症的症状是由实际鼻组织缺失、损害所造成的,所以能够自行痊愈的可能性不高。  Eugene Kern博士首次使用「空鼻症候群」这一名词。他认为,缺乏了鼻甲的保护,剩余的鼻粘膜会暴露在未经过滤、未经调节的空气,从而随时间持续消耗和损坏,空鼻症的症状也会因此逐渐恶化。他表示,当鼻甲组织少于某个临界点后,鼻粘膜就无法从每时每刻的消耗中再生。一项在美国进行的试验在几年的时间内观测了242位进行了各种鼻甲切除术的病人,他们在手术后产生了萎缩性鼻炎。在用电脑断层和直接观察这些病人的异常鼻腔结构后,科学家将这种情况命名为「空鼻症候群」。研究强调病症大大降低了病人的生活质量,而且病情有随时间恶化的趋势。这一研究符合19世纪末医学界采纳鼻甲切除术以来空鼻症患者群体的结论。然而一些长期研究却没有发现长期的负面影响。目前争议仍在持续,但医学界倾向于在进行切除术时尽量保留鼻甲组织。  病患者可以在鼻腔表面涂上保护性凝胶或使用盐水喷剂来补充损失了的水分,从而避免粘膜组织萎缩。不过,完全重建下鼻甲才是解决这一病症的最彻底的方法。  有近期报告表示有可能通过在粘膜下注入填充物来重建下鼻甲。报告中的病人人数很少,后续观察的时段也比较短,但报告的结论是正面的。2010年的一项研究指出,通过手术进一步对「空鼻」进行切除可以改善鼻内气流,但无法改变鼻子调节温度、湿度的能力。这些功能将无法逆转。另一项研究表示,一旦受破坏的鼻粘膜使纤毛细胞退化、损失,则连用手术闭合鼻孔也无法使纤毛细胞重新增长。
title: 目前的治疗方法.
title: 非手术治疗.
content: 非手术治疗通过保持鼻内湿度,避免感染和刺激,以及保证充分的血液供应,可以保持并改善剩余鼻粘膜的健康。
title: 手术治疗.
content: Surgical treatment involves narrowing back the over enlarged nasal cavity—either by bulking up the partially resected turbinates with biological implant material (in cases where at least 50% of the inferior turbinate remain from anterior to posterior) or by creating neo-turbinates through submucosal implantation between the submucosa and bone in key locations in the nasal cavity. Of course, in some cases a combined approach is the best choice. The main difficulty with implant surgery is to achieve a long lasting bulk that will not get absorbed over time. Sometimes a procedure has to be repeated several times to get a sustainable result. The most physiological location for an implant is the lateral wall of the nasal cavity, where the inferior turbinate used to project from. An easier location to implant is the septum, but it is less favorable as it is not the natural location of the turbinates and may over obstruct the airflow.  The underlying rationale of surgery is to restore the natural inner nasal geometrical contours of the nasal passages of air (the inferior, middle, and superior meatuses), as much as possible, to mitigate the airflow just enough to restore normal rates of inner nasal humidity and temperature that will allow the mucosa to recuperate and sense the airflow well enough. It is paramount to do so while trying to restore the normal aerodynamics of the airflow in the nose, otherwise nasal obstruction will occur.  Pre-surgical planning has a tremendous impact on the success of the procedure. The surgeon is advised to perform a cotton test prior to the implantation: the surgeon places saline soaked chunks of cotton wool at the pre-planned site of implantation to simulate the implant. By doing so, he restricts and normalizes the nasal airflow patterns. This restores nasal aerodynamics. By trying different locations in accordance to the patient's feedbacks regarding the quality of his breathing and other ENS symptoms, it is possible to pinpoint the exact placement for the implants and their estimated shape and size.  Turbinate tissue is unique and there are no potential donor sites in the body from which to harvest similar tissue. However, in the nose, form equals function. It is therefore possible to restore some function by restoring the natural contours and proportions of the nasal passages: It is possible to create an artificial look-alike structure of a turbinate in the nasal cavities, and thus to regain some of the nose's capabilities to adequately resist, streamline, heat, humidify, filter, and sense the airflow.
title: Implant materials.
content: The bulking up of the sub-mucosa and mucosa to create a neo-turbinate structure can be achieved through implanting some supporting material between the bone/cartilage and also into the submucosal layer. Many materials have been tried over the past 100 years. In most cases this operation was used to restore heat and humidity to atrophic noses.  Generally speaking, the implant materials can be divided into 3 groups:  The ideal implant material, other than real original turbinate tissue should be something with low extrusion and rejection rates, minimal infection risk, and—very importantly—that will provide a strong and endurable enough structure and at the same time allow good permeability for blood vessel incorporation, which seems to be the key against long term absorption.

Summary: 空鼻症候群,简称空鼻症,(英语:Empty Nose Syndrome,缩写:英语:ENS),在耳鼻喉科学中指的是通过鼻甲切除术过度切除鼻甲(通常为下鼻甲)后所造成的鼻腔异常及一系列并发症。

Empty nose syndrome: Empty nose syndrome (ENS), one form of secondary atrophic rhinitis, is a clinical syndrome in which people who have clear nasal passages experience a range of symptoms, most commonly feelings of nasal obstruction, nasal dryness and crusting, and a sensation of being unable to breathe.