Tympanophonia can be a consequence of a variety of diseases and pathological conditions diagnostics of which encounters difficulties. The comprehensive clinical examination of the patient is necessary to determine the cause of tympanophonia including elucidation of the following characteristics: initial (acute or gradual) sensation of sound in the ear(s), duration of persisting clinical manifestations, the presence of an acoustic or craniocerebral injury, characteristics of the noise, viz. continuous or intermittent, clicking sounds, paroxysmal or pulsed noise (synchronous with the heart beating), fluctuating, audible to the patient alone or to the surrounding people as well, unilateral and bilateral noises (either symmetric or asymmetric), perception of noise in the head rather than ears., high- and low-pitched noise together with the accompanying neurological symptoms. The analysis of these characteristics makes it possible to differentiate between objective and subjective sensation of noise in the ear(s), determine the amount of additional studies needed for the evaluatio of the conditions of a given patient, identify the possible cause of tympanophonia, establish the nosological diagnosis, and distinguish a group of the patients in need of emergency otological management.
The objective of the present work was to study the pathogenetic mechanisms underlying nasal bleeding (NB) in the patients presenting with arterial hypertension (AH). A total of 47 patients with AH suffering from NB were available for the examination of whom 28 experienced a single bleeding episode and 19 had recurrent bleeding. 11 of them were treated by endonasal surgical intervention for the achievement of hemostasis. Simultaneously, mucoperichondreal biopsies were taken from the anterior septal portions and used for histological and ultrastructural investigations. The laboratory examination of all the patients has demonstrated hyperfibrinogenemia and the enhanced level of soluble monomeric fibrin complexes in the blood (especially in the patients with recurrent nasal bleeding) despite the normal platelet levels, prothrombin and thrombin times. These findings gave reason to characterize the hemostasiological status of the patients as chronic compensated disseminated intravascular coagulation (DIC) syndrome. The histological study revealed hyaline, erythrocyte-rich and fibrin thrombi in the vessels of the microcirculatory system whereas ultrastructural studies showed desquamation of endothelial cells, massive desendothelization, and disintegration of the basal membrane with the exposure of subendothelium. It is supposed that these changes provoked the development of thrombosis and focal necrosis in nasal mucosa. The authors conclude that the cause of nasal bleeding associated with arterial hypertension is directly related to the lesions of vascular endothelial, microcirculatory disorders, and modification of the blood coagulation processes rather than to the mechanical rupture of blood vessels. These changes are believed to be responsible for the development of local intravascular coagulation.
Цель-изучить клинические симптомы изолированного поражения клиновидной пазухи. Материал и методы. Проведен анализ 51 истории болезни пациентов, подвергнутых трансназальному вскрытию клиновидной пазухи за период с января 2014 г. по декабрь 2016 г. Обследование включало сбор анамнеза, эндоскопическое исследование, компьютерную томографию, патогистологическое исследование операционного материала. Результаты. Почти у всех больных (50/51) в клинике превалировала головная боль различной локализации, среди других симптомов отмечались затрудненное носовое дыхание, постназальный затек, глазодвигательные нарушения. По нашим данным, головная боль имела весьма вариабельную локализацию. Чаще всего головная боль локализовалась на стороне поражения по типу гемикрании или имела диффузный характер. Заключение. Головная боль является самым частым симптомом изолированного поражения клиновидной пазухи. Больным с подострой и хронической головной болью всегда следует исследовать состояние околоносовых пазух. Ключевые слова: клиновидная пазуха, изолированное поражение клиновидной пазухи, головная боль.
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