RU1811798C - Method for diagnosing chronic vasomotor rhinitis - Google Patents

Abstract

Usage: in medicine in otorhinolaryngology for the diagnosis of forms of chronic vasomotor rhinitis. Objectives. - improving the accuracy of diagnosis. The method involves biomicroscopy and microphotography of the microcirculation of the bisalbar conjunctiva of the eye, first in the resting state of the mucous membrane of the nasal concha, and then with sequential mechanical and chemical irritation of the mucosa of the lower nasal concha. In this case, mechanical irritation is produced by dosed pressure using a knizometer with zero catgut thread, and clinical irritation is by applying a 0.1% solution of adrenaline hydrochloride to the mucosa. The revealed microcirculation indices are scored in a known manner, and then the conjunctival index is calculated using the formula J -. . where J - CONJUNCTIVE indicator; N is the indicator of microcirculation in the resting state of the nasal mucosa; Ki is an indicator of microcirculation after mechanical breakdown. mucosal mucus; Ka is an indicator of microcirculation after chemical exposure to the mucosa. With a conjunctival value of less than 8 diag. nostic allergic form of chronic vasomotor rhinitis, and with a value of more than 8 - neurovegetative. 1 tab. fe

Description

The invention relates to clinical medicine, in particular to otorhinolaryngology, and is intended for the differential diagnosis of forms of chronic vasomotor rhinitis. . The purpose of the invention is to improve the accuracy of diagnosis.

EXAMPLE 1

Patient By the age of 29 (medical history 1664/4138), she was admitted to the clinic complaining of persistent nasal congestion, abundant watery discharge from the nose. In the analysis, the patient was intolerant to novocaine, which indicates 6 tendencies of the body to allergic reactions.

. Rhinoscopy results: the nasal passages are sharply narrowed due to edema and swelling of the mucous membrane of the lower nasal concha. A cytological examination of the detachable nasal cavity indicated moderate allergization. Based on the analysis of clinical and laboratory data, the diagnosis was made — an allergic form of chronic vasomotor rhinitis. This diagnosis was confirmed by examining the patient.

1st year

bom-lrototype. According to the diagnosis, the patient was prescribed non-specific hyposensitizing therapy, after which the patient's condition did not worsen. After that, the disease was diagnosed by the proposed method — the patient examined the state of microcirculation of the vascular bed of the bulbar conjunctiva of the eye, initially in the resting state of the nasal mucosa. For this purpose, the capillary M-70A with a 70-fold magnification carried out microphotography of the conjunctival site with the most pronounced vascularization and, using the obtained microphotographs, the indicators characterizing the changes detected in the vessels, outside the vessels and inside the vessels were evaluated in a known manner using points. The microcirculation index of the bulbar conjunctiva of the eye in the resting state of the nasal mucosa (N) was determined as the sum of the score indicators characterizing the revealed individual manifestations of a vascular, extravascular and intravascular nature.

Then the same vascular zone of the bulbar conjunctiva of the eye was examined, but with sequential conduction of first mechanical and then chemical irritation of the mucosa of the lower nasal concha. Mechanical irritation was carried out by a knizometer with a zero catgut thread, touching the free end of the thread of the mucosal section for another about 1 cm and applying a dosed pressure of 0.1 ± 0.02 g per mucosa, after which microphotography of the test area was carried out immediately. After the vascular reactions due to mechanical action disappeared, chemical irritation was performed, for which the visible mucosa of the lower nasal concha was smeared with 0.1% adrenaline hydrochloride solution and microphotography of the test area of the bulbar conjunctiva of the eye was immediately performed. Moreover, microcirculation indices of the bulbar conjunctiva of the eye after mechanical irritation of the mucosa (C) and after chemical exposure to the mucosa (K2) were determined similarly to the determination of the microcirculation index of the bulbar conjunctiva of the eye in the resting state of the nasal mucosa (N).

Certain indicators of microcirculation N 8 points; Ki 12 points; "2 10 points,.

The calculated conjunctive indicator in this patient was

8 12 10

 9.6 points

Diagnosed; neurovegetative - a form of chronic vasomotor rimitis. The patient was prescribed laser therapy in combination with sedatives. The treatment carried out significantly improved nasal breathing. Patency of nasal passages

improved from 49 to 11 mm of water. Art. on the right and from 52 to 3 mm of water. Art. left. The patient was discharged in satisfactory condition. The example confirms the high diagnostic accuracy of the proposed method, which

allowed to choose an adequate treatment.

Example 2. Patient D, 56 years old (medical history Ns 2253/3513), was admitted to the hospital with complaints of difficulty in nasal breathing, severe headaches, pain, nasal discharge, and sneezing attacks.

In the analysis, there was a post-mucosal resection of the nasal septum, which did not lead to a noticeable improvement in nasal breathing. Objective study: the general nasal passages are narrowed, the mucosa of the lower nasal concha is pale, anemic, there is an increase in edema to the posterior ends of the lower nasal concha, in places a barely noticeable vascular pattern. A clinical blood test found: eosinophils 3%, allergy tests - weakly positive (+ +). Based on the data of clinical and laboratory studies, it was not possible to determine

form of vasomotor rhinitis. The patient was also examined by the prototype method and the proposed method.

When examining a patient for diagnosis in a known manner on

microphotograms revealed changes in the mucous membrane of the nasal cavity, characteristic of both allergic and neurovegetative forms of rhinitis, which did not allow to accurately diagnose the disease.

For the diagnosis of the proposed method carried out analogously to example 1, the study of microcirculation of the bulbar conjunctiva of the eye in a state

rest and after mechanical and then chemical irritation of the mucosa of the lower nasal concha. .

Microcirculation indices N b points; CZK 8 points; Ka 7 points. .

Indicators of rmnite form amounted to

6.9.

Diagnosed with allergic form of chronic vasomotor rhinitis.

The correctness of the diagnosis and the selected adequate treatment is confirmed by the positive effects of the local and general desensitizing non-specific therapy. The patient was discharged in satisfactory condition.

The proposed method diagnosed chronic vasomotor rhinitis, similar to the described examples, 46 patients; including an allergic form of the disease in 22 patients and neurotransmitter in 24 patients.

For comparison, the table shows the diagnostic data of the prototype method.

These tables indicate the high accuracy of the proposed method. The statistical difference in the values of the conjunctival index for various forms of rhinitis is significant (, 01).

The method can be widely used in medical practice, since its implementation is based on the use of inexpensive, commercially available equipment.

Claims (3)

SUMMARY OF THE INVENTION 1. A method for diagnosing chronic vasomotor rhinitis, comprising a regional study. vascular microcirculation by biomicroscopy, microphotography and assessment of the revealed microcirculation indices in points, characterized in that, in order to improve the accuracy of diagnosis, microcirculation of the tabloid conjunctiva of the eye is examined during sequential mechanical and chemical irritation of the mucous membrane of the lower nasal shells, and conjunctival exponent J according to the formula J NKi / K2, where N is the microcirculation index in the resting state of the nasal mucosa; KI - the same after physical irritation of the mucosa; K2 - the same, after a chemical effect on the mucous membrane, moreover, with an indicator value of less than 8, the allergic form is determined, and with a value of more than 8 it is neuro-vegetative. 2. The method according to claim 1, wherein the mechanical irritation of the mucous membrane of the lower nasal turbinates is produced by dosed pressure using a knizometer with zero catgut thread. 3. A method according to claim 1, wherein the chemical irritation is carried out by applying a 0.1% solution of epinephrine hydrochloride.