亂用藥鼻塞變鼻病

鼻塞是耳鼻喉科醫生最常聽到病人投訴的問題。這是一個十分擾人的徵狀，日間會令人呼吸不順，晚上更會使患者張口睡覺，引起鼻鼾及口乾等問題。鼻敏感、傷風感冒都會引致鼻塞，誤用噴鼻藥物、鼻內有息肉及結構異常，甚至是發病率甚高及可致命的鼻咽癌 (nasopharyngeal carcinoma)，也會令人「條氣唔順」，但很多人都忽視鼻塞問題，任由呼吸道長期有阻塞也不理，又或是胡亂用藥通鼻，令原本可能是小小的問題，逐漸變成長期性鼻病。

臨床經驗顯示長期鼻塞很多時是長期鼻敏感控制不好，引起下鼻甲骨黏膜肥大 (turbinate hypertrophy)。下鼻甲骨十分貼近鼻道出口，本來不會擋住呼吸道，但鼻敏感會促使包裹着鼻甲骨的黏膜充血放大，長期如此就會令黏膜逐漸發脹，繼而阻塞呼吸道。因此很多鼻敏感患者不但發作時會鼻塞，就算平日敏感症狀沒出現時也會覺得呼吸不順。

很多人以為鼻塞不是大問題，但其實它可以誘發其他問題出現，例如鼻鼾、改用口呼吸而出現口乾、口臭及咽喉發炎等等。下鼻甲骨黏膜肥大的患者可以激光或射頻除掉腫脹的組織，加上平日按醫生指示好好控制鼻敏感，就可以紓緩及減少鼻塞問題。

Sources:
http://the-sun.on.cc/cnt/news/20101116/00410_032.html

Allergic rhinitis

Allergic rhinitis affects about 1/3 of the US population. Morbidity from this disease leads to decreased productivity, lost work/school days, and increasing costs of medical care and treatment. It is an important entity for the practicing otolaryngologist because many of these patients have failed medical management. In order to treat these patients, allergy testing may need to be performed in order to start vaccine immunotherapy.

Inflammation of the membrane lining the nose secondary to hypersensitivity to aeroallergens, characterized by rhinorrhea, sneezing, pruritis, congestion, post nasal drip and associated conjunctival, otologic or pharyngeal inflammation. These symptoms can be episodic, seasonal or perennial. Severity ranges from mild, to seriously debilitating with excess days of missed school or work. Risk factors include family history of atopy, serum IgE > 100 IU/ml before age six, higher socioeconomic class, exposure to aeroallergens, presence of positive allergy skin prick test.

Prick/scratch testing (SPT) is a superficial skin reaction that does not penetrate dermis. It is highly specific, sensitive, convenient and safe. A test is positive if there is a wheal and flare reaction which is greater than or equal to the histamine control.

Intradermal testing (IT) a dilute antigen extract is injected into the dermis, and a superficial wheal forms. After ten minutes, the wheal is measured again to see if there was any progression. If the diameter of the wheal has increased by 2mm or greater, then a positive response has occurred. This causes relatively minimal patient discomfort.

Immunotherapy is a viable option for patients not benefiting from traditional medical management (eg. nasal steroid spray, antihistamine, etc.) that works by altering one’s immunologic response. Adjuvant therapies may be useful to maximize effect of immunotherapy.

Source:
Medical Management of Allergic Rhinitis UTMB Dr. Quinn's online textbook of Otolaryngology [Apr 30, 2009]