鼻中隔彎曲症의 임상적 고찰

Abstract

[한글]

著者는 鼻中隔彎曲症의 臨床的考察이라는 題目下에, 1956年 4月 1日부터 1957年 3月 31 日까지의 1年間, 세브란스病院 耳鼻咽喉科를 訪問한 外來患者中 鼻中隔彎曲症으로 診斷을 받은 患者 總 249名에 對하여 原因的關係 及 年齡的關係, 全耳鼻咽喉疾患 及 鼻科疾患에 對한 頻度, 彎曲側과 彎曲의 種類, 臨床的症候 及 그 呼訴期間의 比較 彎曲側과 反對側에 共存한 鼻科疾患과의 相互關係, 그리고 共存한 他臟器의 疾患等 全般에 걸쳐 考察하였다.

그 結果 原因的關係는 過去 特히 어렸을 때 鼻外傷을 받은 者가 5名(2.01%) 鼻茸에 依한 壓迫으로 因한 者가 3名(1.2%) 나머지 241名(96.19%)은 先天的 及後天的 發育異常으로 본다. 性別은 男子가 211名(84.74%) 女子가 38名(15.26%)으로서, 男子가 女子의 約 5.5

倍이다. 年齡的關係는 4歲부터 64歲까지 있으며 그 中 18歲에서 23歲까지의 靑年層에 가장 많으며, 146名(58.68%)으로서 全體의 半以上을 차지하고, 그 中에서도 20歲에서 가장 많으며 36名(14.46%)이다. 이보다 年令이 연소하거나 많을수록 그 數는 차차 적어진다. 耳鼻咽喉科患者 總 3872名에 對한 鼻科患者 總 996名의 頻度는 25.72%이고 鼻中隔彎曲症患者 總 249名은 6.44%이다. 그리고 全鼻科患者에 對한 鼻中彎曲症의 頻度는 25%로서 1/4에 該當할 種類는 이 5名(2/01%) 이 55名(22.09%) 單純彎曲症이 123名(49.40%), 分類되지 않은 것이 66名(26.50%)이다. 彎曲側을 比較하면 右側彎曲이 89名(35.74%), 左側彎曲이 137名(55.02%), 兩側彎曲이 8名(3.24%)이고 左側彎曲이 가장 많으며 全體의 1/2以上을 차지하고 있다. 臨床的症候를 보면 鼻閉鎖가 174名(70%)이고, 彎曲側과 同側에 18名(1

0.8%) 反對側에 1名(0.6%), 兩側에 11名(6.6%), 分類되지 않은 例가 144名(82%)이다. 頭痛은 153名(61.45%)이며 鼻漏는 117名(47%), 嗅覺障害가 22名(8.84%), 記憶力減退 及 注意力減退가 17名(6.83%), 全身倦怠感이 17名(6.8%), 後鼻孔漏가 13名(5.22%), 鼻內痂皮形成이 7名(2.8%), 鼻出血이 8名(3.2%), 鼻內疼痛이 6名(2.4%), 鼻內乾燥感이 8名(3.2%) 等이고 聽覺障害가 25명(10.04%), 視力障害가 4명(1.61%), 耳漏는 4名(1.61%) 그밖에도 鼻聲音 呼吸困難 神經喪 耳鳴 聲 不眠症 咳嗽 眩鼻 等도 若于있다. 이런 症候들의 呼訴期間은 1個月 以內가 46名(18.48%), 1年이 52名(20.88%)으로서 가장 많다. 共存한 鼻科疾患을 보면, 慢性上 洞炎은 全部 46名(18.4%)이며 彎曲側과 同側에 9名(19.5%) 反對側에 10名(21.5%) 兩側에 16名(34.4%) 分類되지 않은 것이 11名(24.6%)이다. 肥厚性鼻炎은 全部 58名(23.2%)이며 彎曲側과 同側에 1名(1.7%) 反對側에 22명(37.4%) 兩側에 28名(47.6%) 分類되지 않은 것이 7名(13.3%)이다. 鼻茸 及 茸 中甲介는 全部 12名(4.8%)이며 彎曲側돠 同側에 1명(8.3%) 反對側에 3名(24.9%) 兩側에 5名(41.5%) 分類되지 않은 것이 3名(25.3%)이다.

그外도 急性鼻炎이 3名(1.2%) 慢性鼻炎 性鼻炎 等이 各各 1名 이었다. 共存한 他臟器의 症患을 보면 慢性中耳가다루는 全部 8名(3.4%)이며 彎曲側과 同側에 2名 反對側에 2名 兩側에 4名이고 慢性化膿性中耳炎은 全部 3名(1.2%)이며 彎曲側과 同側에 2名, 反對側

에 1名이고 慢性肥厚性 扁桃腺炎이 11名(4.4%) 性咽喉頭炎이 5名(2.0%) 耳癤이 2名(0.8%)이다.

過去에는 頭痛이나 鼻閉鎖 鼻 等을 主訴로 病院을 訪問한 患者에게, 甲介切除術, 鼻茸摘出術, 上 洞切開術, 內科的對症療法 等을 많이 했으나, 이런 治療方法들만으로서는 患者의 苦痛을 完全히 除去하지는 못하였다. 그러나 그런 患者들에게 있는 鼻中隔彎曲症

을 矯正해줌으로서 患者의 苦痛을 많이 除去할 수 있게 되었다. 그러므로 著者는 特히 18歲 乃至 23歲사이의 젊은 靑年 學生層에 많은, 鼻中隔彎曲症에 對한 重要性을 認識하고 이에 對한 考察로서 不足하지만 耳鼻咽喉科學界뿐만 아니라 一般醫學界 及 社會에도 多少 나마 貢獻이 될 수 있기를 祈願하는 바이다.

[영문]

The author generally describes the clinical survey of septal deflection on the etiology, sex, age, incidence, classification, deviated side, clinical manifestations, relationship between septal deflection and coexisting shinologic diseases and coexisting diseases of other organs, from 249 patients who visited Severance Hospital for one year from April, 1956 to Mar. 31, 1967.

Etiology : Of 249 cases, 5 cases (2.01%) had grauma on the face in the past, especially in the childhood, 3 cases (1.2%) had pressure factor by nasal polyps, and the rest, 241 cases (96.19%) seem to be developmental origin as there was no contributing acquired cause and as they have higher arched palate.

Incidence : Of 249 cases, 211 cases (84.7%) are made. This is more frequent in male than female, male is about 5.5 times as many as female. All the cases are distributed on the group from 4 to 64 years of age, among them the young adults, from 18 to 23 years of age, occupies 146 cases (58.68%), and this is more than a half of all cases. Most of the young adults are students, and so this is the great problem in this symmetrically. For total 3872 cases of ear, nose and throat patients, total 996 cases of rhinologic patients are 25.72 per cent and total 249 cases of septal deflection are 6.44 per cent. But the incidence of septal

deflection for the shinologic patients is 25 per cent and a quarter, and so septal deflection is one of the common and improtant rhinologic diseases.

Classification : The author classifies the septal deflection into 3 types : spina, orista and simple deviation. There are 5 cases (2.01%) of spinam 55 cases(22.09%) of crista, and 123 cases (49.40%) of simple deviation. The rest, 66 cases are unclassified. Among them simple deviteresting thing to observe the direction of the deflection. By the author's survey, there are 137 cases (55.02%) of septal deflection to the left side and 89 cases (35.74%) of septal deflection to the right side. The left side is more frequent than the right side, and occupies about a half of all cases.

Clinical Manifestations : - There are various symptoms and signs of this diseases : there are 174 cases (70%) of nasal obstruction which is the most important subjective symptom, and it is mainly in the convex side, but alternating stuffiness is not uncommon. Headache is the next important and most troublesome subjective symptom. In this survey, there are 153 cases (61.46%). Of course, there are various degrees in headache, but frontal headache is more frequent than any other regional headaches. This headache interrupts the young students who have this disease, and

1st them visit the hospital forits relief. Rhinorrhea is also an important symptom and there is 117 cases (47%). This rhinorrhea is probably hypersecreted by the inflammation of the mucosa of nasal cavity and accessory sinuses. Its character is purulent and ratory of serous. The purulent dischargo usually has a foul odor, and there are 86 cases all together, and it is about 2.8 times as many as watery or serous rhinorrhea. Hyposmia or anosmia due to the nasal obstruction that prevents the inspired air current to reach the nasal roof area where the offactory nerve endings are distributed. There are 22 cases (8.84%). There are 17 cases of general malaise, 13 cases of postnasal drip, 17 cases of amnesia and aproseria nasalis, 8 cases of spistaxis, 7 cases of crust formation in the nasal cavity, 6 cases of pain in the nose, 8 cases of dryness in the nasal cavity, 25 cases of hearing impairment, 4 cases of visual disturbance, and 4 cases of otorrhea. Besides these there are rhinolalia, dyspnea, neurasthenia, tinnitus, hoarseness, insomnia, cough and dizziness. Duration of ohief complaints is variable; 46 cases before one month and 52 cases in one year duration are the highest peak, and after then the cases are gradually deoreased.

Relationship between the septal deflection and the coezisting Rhinologio diseases; Chronic manillary sinusitis is the most important and frequent disease. There are 46 cases (18.4%) of all cases. Especially it is more frequent in the concave side, because hyperventilation and the easily invaded inflammation disturb the physiological funotions of cilia and mucosa in the nasal cavity and accessory sinuses. But there are many cases in both sides, this seems to be due to the long duration of ohief complaints without any treatment or by the improper treatment.

Hypertrophic turbinate is also important, and it is sometimes inflammatory. The most of them are hypertrophy of the inferior turbinates, especially the inferior turbinate of the concave side is physiologioally enlarged to control the nasal air current. It is a sort of adjusting phenomenon. But there are many cases in both sides, this is also the reason as in the chronic maxillary sinusitis. There is 58 cases (23.2%) of hypertrophic rhinitis of all cases. There are 12 cases (4.8%) of nasal polyp and polypcid middle turbinate of all cases. There are also more frequent is the concave side, and these are very important factor in the etiology of this disease. Besides these, there are some acute rhinitis, chronic rhinitis and strophic rhinitis, but their relationship with this disease is not clearly mown.

Relationship between the septal defletion and the ocexistion diseases of other organs; -Chronic Catarrhal Otitis Media is one of the common diseases in this subject. By the author's survey, there are 8 cases (3.2%) of all cases, and the half of them are bileteral. It seems to be due to the direct transmission of the

inflammation from the nose to the ear for a long time. But it can be occurred primarily. There are 11 cases(4.4%) of ohronic hypertrophic tonsillitis, 5 cases of chronic pharynglaryngitis, 3 cases of chronic purulent otitis media, and 2 cases of otofuruncle. These diseases can be occurred primarily too, but usually the infection that is originated from the nose provokes these diseases gradually.

In the past, the patients who had headache, stuffiness, gyperrhinorrhea etc, were treated by the manner of turbinectomy, polypectomy, sinusotomy, medical symptomatic therapy etc,. Nevertheless their sufferings were not relieveed completely, they

were only relieved by the septectomy, the correction of the septal deviation that were existed in these patients at the same time. And so the author recognised the importance of this disease that is mainly complained by the young students, and studied this disease clinically. This thesis is poor and has less cases. However, the author hopes this thesis can be contributed somewhat to the field of otolaryngology, medioine and the society.