Nasal septum abscess is a limited cavity in the submucosal layer of the cartilaginous part of the nasal septum, filled with purulent masses. The main manifestations of the disease are nasal breathing disorders, local soreness, headache, hyperthermia and general weakness. The diagnostic program includes anterior rhinoscopy, routine laboratory blood tests, puncture of the nasal abscess and bacterial seeding of the resulting purulent masses. Treatment involves surgical autopsy, drainage of the abscess and antibiotic therapy, selected taking into account the sensitivity of the sown microflora.
J34.0 Abscess, furuncle and carbuncle of the nose
Most cases of the disease are associated with hemorrhage in the septum tissue against the background of injuries to the nose and adnexal sinuses, followed by infection of the resulting hematoma. The formation of abscesses occurs in 1.1% of patients with traumatic injuries of the facial part of the skull. Much less often, nasal septum abscesses occur as an independent disease or complication after surgery, inflammatory or infectious pathologies of the nose. Seasonal and geographical features of the distribution are not traced. In men and women, an abscess of this localization occurs with the same frequency.
Causes of nasal septum abscess
Nasal septum abscess can form as an independent primary disease or act as a complication of other pathologies. Typical bacterial pathogens of the purulent process are beta-hemolytic streptococcus group A, golden and epidermal staphylococci. The following etiological mechanisms are significant in the development of the disease:
- Suppuration of a hematoma. The most common cause, which is associated with injuries to the nasal region and subsequent infection of a non-emptied nasal septum hematoma in time.
- Damage to the nasal mucosa. It is characterized by the penetration of pathogenic microflora in places of violation of the integrity of the mucous membrane. Such injuries can be caused by careless actions of the patient himself (when cleaning the nasal passages with fingers or cotton swabs) or surgical interventions.
- Complication of other diseases. An abscess can be a consequence of inadequate treatment of a boil, erysipelas, infectious diseases of the nasal cavity. Also, the pathological process with periodontitis, caries, osteomyelitis of the upper jaw can spread to the nasal septum.
Factors that contribute to the formation of an abscess, worsen its course and the effectiveness of treatment include endocrine pathologies (diabetes mellitus), immunodeficiency conditions (HIV infection, oncohematological diseases), lack of nutrients and vitamins caused by irrational nutrition or disorders of the digestive tract.
The mechanisms of abscess development may differ depending on the etiological variant. A hematoma, which is an accumulation of blood between the cartilage and the cartilage or the cartilage and the mucous membrane, contributes to the rapid development of inflammation. As a result, a large amount of biologically active substances is released and secondary alteration occurs. All this leads to a local decrease in resistance, infection of the blood mass with pyogenic bacteria, the formation of an abscess and a pyogenic membrane.
When microtraumas of the nasal mucosa are infected with pyogenic staphylococci and streptococci, inflammatory reactions increase, tissue trophic disorders occur and a large amount of fluid exits the vascular bed. In the future, as the exudate accumulates, the formation of the abscess cavity and the pyogenic shell occurs. With the penetration of bacteria from other foci of infection (by contact, hematogenic or lymphogenic pathways) and with ineffective treatment of existing diseases of the nasal cavity, the pathogenesis of the abscess is approximately the same, and the differences are only in the triggering mechanisms and the rate of development.
Symptoms of nasal septum abscess
Often, the first clinical manifestations of nasal septum abscess are deterioration of nasal breathing, a decrease or complete loss of sense of smell. In some cases, patients can independently note the appearance of an increasing formation inside the nasal passage, feel it palpationally. With one- or two-sided localization of the pathological process, there is a “stuffiness” of the right, left or two nostrils at once. In the latter case, the patient is forced to switch to oral breathing.
There is a feeling of discomfort and swelling in the nose, headache of a permanent or intermittent nature, swelling and hyperemia of the external nose and adjacent tissues. These symptoms are also characteristic of hemorrhage in the nasal septum, therefore, against the background of trauma, they are not reliable criteria for an abscess.
A sign of infection of a hematoma or the independent development of an abscess is an increase in body temperature to 38.5-39.0 oC in the presence of all the above-mentioned symptoms. In parallel, there are other manifestations of intoxication syndrome – general weakness, malaise, constant headache. Pain in the nasal area increases significantly, which worsens even with minimal tactile impact.
A characteristic feature of the abscess of this localization is the rapid development of complications – after a few days, the quadrangular cartilage is drawn into the process. As a result of purulent melting of the latter, perforation of the septum occurs with further deformation of the back of the nose, its sinking and the formation of a pronounced cosmetic defect.
There is also a high risk of spreading pathogenic microflora with blood flow into brain tissue. This is due to venous outflow from the nasal septum through the anterior facial and orbital veins into the cavernous sinus. As a result of hematogenic dissemination, orbital phlegmons, purulent thrombophlebitis of the facial veins, septic thrombosis of the cavernous sinus, meningitis, encephalitis and other dangerous complications can form.
The main diagnostics includes the collection of patient complaints and anamnesis data, physical examination and laboratory tests. Hardware imaging methods (ultrasound of the adnexal sinuses, radiography, CT and MRI of the facial skull) are used in the presence of symptoms indicating complications or concomitant damage to the facial bones.
- Anterior rhinoscopy. Examination of the nasal passages allows the otolaryngologist to visually determine the general thickening of the nasal septum, bright red or cyanotic protrusions of the mucous membrane on one or two sides. With the formation of large abscesses, the defect of the septum can be seen immediately when the tip of the nose is raised. When using a probe or a cotton swab, the symptom of fluctuation is determined.
- Diagnostic puncture. For the purpose of differential diagnosis between a hematoma and an abscess, a puncture of the nasal septum protrusion and aspiration of the contents is performed. Receiving blood is a sign of a hematoma, and pus is an abscess.
- Bacterial seeding of purulent masses. Allows you to identify the type of pathogenic microflora and determine its sensitivity to various groups of antibacterial drugs.
- Laboratory tests. Blood tests show nonspecific changes characteristic of any inflammatory disease – leukocytosis, a shift of the leukocyte formula to the left, an increase in ESR.
Differential diagnosis is also performed between abscess and neoplasms of cartilage and bone tissue of the nasal septum. The slow, gradual development of symptoms, the absence of fluctuation, inflammatory changes in the blood test indicate in favor of tumors.
Treatment of nasal septum abscess
In modern otolaryngology, an integrated approach is used in the treatment of nasal septum abscess. It implies the simultaneous use of pharmacotherapeutic agents and direct emptying of the purulent cavity surgically. This approach prevents the development of local complications and prevents the spread of bacteria in the patient’s body.
- Opening of the septal abscess. It consists in dissecting the mucosa, evacuating all purulent masses, washing the cavity with antiseptic solutions and setting drainage. All manipulations are performed under regional anesthesia. Next, a double-sided tamponade of the nasal passages is carried out for a period of 24-48 hours or a through U-shaped seam is applied to the septum. In case of traumatic or septic deformation of the quadrangular cartilage or damage to bone structures, the emptying of the abscess is carried out simultaneously with reconstructive measures.
- Antibiotic therapy. The pharmacological group and the specific drug, dose and frequency of administration are determined by the attending specialist for each patient individually. The selection criteria are the type and sensitivity of the seeded microflora, the severity of the underlying pathology, the presence of complications, concomitant diseases, individual characteristics of the patient (age, allergies, etc.). The most commonly used antibiotics are from the groups of penicillins, cephalosporins, macrolides and their combinations.
Prognosis and prevention
The prognosis depends on the timeliness of medical care. Against the background of early drainage of the abscess cavity, it is often possible to avoid nasal deformity and the development of other complications, and the duration of hospitalization is no more than 10 days. In severe cases with the development of cavernous sinus thrombosis or septic brain tissue damage, the outcome directly depends on the severity of the patient’s condition and the effectiveness of therapeutic measures.
Preventive measures include the prevention of injuries to the facial area and nose, early puncture and drainage of nasal septum hematomas, modern treatment of ENT pathologies, rehabilitation of other foci of infection, correction of systemic pathologies and factors contributing to a decrease in immunity, compliance with the rules of hygiene of the nasal cavity.