课程名称

耳鼻咽喉科学

授课题目

急、慢性鼻窦炎 （双语）

授课教师

苏俊波副主治医师

授课对象

2022级影像本科

学   时

1.5学时

教   材

耳鼻咽喉头颈外科学(第8版) 田勇泉/本科临床/十二五普通高等教育本科国家级规划教材

田勇泉，韩东一，迟放鲁 等 编 北京 人民卫生出版社

一、知识目标：

1、掌握鼻窦的分组及引流位置，熟悉鼻窦炎的临床表现。

2、了解慢性鼻窦炎的手术方式。

二、思政目标：

从鼻窦炎手术方式的改进，逐渐从损伤重的根治性手术向损伤小的微创手术发展，让学生体会老一辈医学家努力提高医疗水平，真心关怀患者疾苦的情怀和责任。激励学生们勤奋学习，不断创新的精神。

三、技能目标

1.培养学生分析问题的能力：以鼻窦炎的发病机理，结合解剖知识，引导学生分析为什么会出现相应的临床表现。

2.培养学生临床思维能力：以临床病例导入，引导学生思考并分析鼻窦炎的诊断和治疗

教学重点：

讲解鼻窦炎的临床表现，强调治疗原则

教学难点：

不同鼻窦的急性炎症临床表现的区别

外语要求：

掌握重点词汇的英语表达 （鼻窦炎 sinusitis；鼻窦  sinus ；窦口鼻道复合体OMC ）

教学方法、辅助手段：

应用幻灯片、图片、投影、模型等进行问题引导性教学，应用对比、病案等教学手段

参考资料：

Ballenger’s OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 17th  2009

孔维佳 周梁等主编《耳鼻咽喉头颈外科学》  人民卫生出版社 2015年

教学内容、方法

思政内容

时间分配及教学方法手段

教学内容、方法、及时间分配：

sinusitis

一、Anatomy of the nasal sinuses

1、Anterior sinus :

          maxillary sinus

          frontal sinus

          anterior ethmoidal sinus

          They all open in the middle meatus.

2、Posterior  sinus:

          posterior ethmoidal sinus :open in the superior meatus

          sphenoid sinus: open in sphenoethmoidal recess

二、concept of sinusitis

 1、Sinusitis has been defined as an inflammation of the mucous        membrane of the  sinuses.

2、two types- acute  sinusitis and chronic  sinusitis.

三、Acute sinusitis

1、Aetiology of sinusitis in general

（1）Exciting causes

                 Nasal infection

Swimming and diving

Trauma

Dental infection

 (2) Predisposing causes

                 1）local

                      1）nasal packing

                      2）deviated septum

                      3）hypertrophic turbinates

                      4）nasal polypi

                      5）oedema of sinus ostia due to allergy or vasomotor rhinitis

                      6）benign or malignant neoplasm

2） General

                      1）Environment :

                      2）Poor general health

2、Bacteriology

             Viral infection ------bacterial invasion

pneumoniae,  influenzae

Anaerobic organisms and mixed infections

 3、Pathology of sinusitis

 4、Clinical features

               (1)Acute maxillary sinusitis

                  1)Constitutional symptoms

                  2)Headache

                  3)Pain

                  4)Tenderness

5) Redness and oedema of cheek

                  6)Nasal discharge

 (2)Acute frontal sinusitis

                   1) Frontal headache

                   2)Tenderness

                   3)Oedema of upper eyelid with suffused conjunctiva and photophobia.

                   4)Nasal discharge

 (3)Acute ethmoid sinusitis

                   1)Pain

                   2)Oedema of lids

                   3)Nasal discharge

                   4)Swelling of the middle turbinate

(4)Acute sphenoid sinusitis

                   1)Headache : occiput  or  vertex

                   2)Postnasal discharge

5、Diagnosis

               X-rays or CT scan :  an opacity or a fluid level in the involved sinus.

            6、Treatment

              1）Antimicrobial drugs

              2）Nasal decongestant drops

              3）steroids

              4）Analgesics

四、chronic sinusitis

 1、In general：

Sinus infection lasting for months or years is called chronic sinusitis.

2、pathophysiology

            Persistence of infection causes mucosal changes, such as loss of cilia , oedema and polyp formation, thus continuing the vicious cycle.

 3、Pathology

           In chronic infections , process of destruction and attempts at healing proceed simultaneously.

Sinus mucosa becomes thick and polypoidal or undergoes atrophy.

  4、Bacteriology

                Mixed aerobic and anaerobic organism are often present

   5、Clinical features

               1）Clinical features are often vague and similar to those of acute sinusitis but of lesser severity.

               2）Purulent nasal discharge is the commonest complaint.

               3）Foul-smelling discharge suggests anaerobic infection.

               4）Local pain and headache are often not marked .

               5）Some patients complain of nasal stuffiness and anosmia.

             6、Diagnosis

             7、Treatment

               1）It is essential to search for underlying aetiological factors which obstruct sinus drainage and ventilation.

               2）A workup for nasal allergy may be required.

               3）Culture and sensitivity of sinus discharge helps in the proper selected of an antibiotic.

               4）Initial treatment of chronic sinusitis is conservative, including antibiotics, decongestants, antihistaminics  and steroids .

               5）Some form of surgery is required either to provide free drainage and ventilation or radical surgery to remove all irreversible diseases

               6）Recently , endoscopic sinus surgery is replacing radical operations on the sinuses and provides good drainage and ventilation.

功能性鼻窦内窥镜手术为慢性鼻窦炎热点，结合目前进展介绍相关治疗新展，引出科研创新之路的重要性，启迪学生科研创新意识，培养科研创新精神和能力。

5min

结合图片，让学生给容易掌握

3min

8min

结合图片分析各种引起鼻窦窦口阻塞的因素

2min

2min

15min

重点在不同鼻窦炎之间的区别。

额窦炎头痛特点是难点，需要学生掌握为什么会出现这样的特点

2min

5min

2min

1min

1min

5min

重点在于急性鼻窦炎临床表现的区别

9min

运用视频治疗，让学生了解FESS手术的特点

思考题：

•        1.上颌窦炎发病率高的解剖因素？

•        2. 下鼻道内见脓性分泌物考虑哪个鼻窦炎，为什么？

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