what are adenoids腺样体是什么the nasal pharyngeal tonsils commonly called adenoids is situated at the junction of the roof and posterior wall of the nasal pharynx咽扁桃体俗称腺样体,位于鼻咽的顶壁和后壁Adenoid tissue is present at birth shows physiological enlargement up to the age of six yearsandthen tends to atrophy at puberty and almost completely disappears by the age of 20出生时存在的腺样体在六岁时显示出生理上的增大,青春期开始萎缩,20岁时几乎完全消失why and when do they cause trouble腺样体在什么时候会带来困扰?为什么?adenoids are subject to physiological enlargement and childhood在儿童期,腺样体容易发生生理性增生certain children have a tendency to generalize the lymphoid hyperplasia in which adenoids also take part某些儿童有广泛的淋巴结增生,其中腺样体也同时肿大recurring attacks of rhinitis sinusitis or chronic tonsillitis may causechronic adenoidal infection and hyperplasia鼻炎、鼻窦炎或慢性扁桃体炎的反复发作可引起慢性腺样体炎和增生allergy of the upper respiratory tract may also contribute to the enlargement of adenoids上呼吸道过敏也可能导致腺样体肿大clinical features symptoms and signs depend not merely on the absolute size of the adenoid mass but a relative to the available space in the nasopharynx临床特征、症状和体征不仅取决于腺样体的绝对大小,而且与其相对于鼻咽部的可用空间有关enlarged and infected adenoids may cause nasal oral ear or general symptoms肿大和感染的腺样体可引起鼻、口、耳或一般症状A nasal symptoms1 nasal obstruction is thecommonest symptomthis leads to mouth breathingA鼻腔症状:1鼻塞是一种常见症状,这导致口呼吸nasal obstruction also interferes with feeding or sucklinga child as respiration and feeding cannot take place simultaneously鼻塞也干扰喂养或哺乳,因为儿童不能同时进行呼吸和进食a child with adenoids and large men fails to thrive腺样体增值影响儿童发育2 nasal dischargeit is partly due to choanal struction as the normal nasal secretions cannot drain into nasal pharynx and partly due to Associated chronic rhinitis2鼻涕:部分原因是由于后鼻孔的结构,正常的鼻分泌物不能流进鼻咽,部分原因是由于相关的慢性鼻炎the child often has a wet bubbly nose儿童经常有鼻涕气泡3 sinusitis chronic maxillary sinusitis is commonly associated with adenoids3鼻窦炎慢性上颌窦炎通常与腺样体相关it is due to persistence ofnasal dischargeand infection这是由于持续的鼻腔分泌物和感染reverse is also true that a primary maxillary sinusitis may lead to infected and enlarged adenoids相反,原发性上颌窦炎可能导致腺样体的感染和肿大4epistaxiswhen adenoids are acutely inflamed a piece taxi can occur with nose blowing4鼻出血:腺样体急性感染时可以伴有鼻出血5 voice change which is toneless and loses nasal quality due to nasal obstruction5.声音变化因为鼻塞导致鼻音加重B oral symptomsB:耳部症状1 tubal obstruction:adenoid mass blocks the eustachian tube leading to retracted tympanic membrane and conductive hearing loss1.咽鼓管阻塞:由于腺样体阻塞咽鼓管导致鼓膜内陷和传导性耳聋2recurrent attacks of acute otitis media or infection of middle earmay occur due to spread of infection via the eustachian tube because the eustachian tube is blocked due to adenoids hypertrophy2.由于咽鼓管因腺样体肥大而阻塞,经咽鼓管传播的感染可导致急性中耳炎复发或中耳感染3chronic suppurative otitis media or long-standing infection of middle ear occursif the otitis media fails to resolve in the presence of infected adenoids3.如果有受感染的腺样体存在时,中耳炎不能消退会发生慢性化脓性中耳炎或中耳长期感染C general symptomsC:一般症状1. adenoid faces:chronic nasal obstruction and mouth breathing lead to characteristic facial appearance called adenoid face1.腺样体面容 慢性鼻塞和口呼吸导致的特征面部外观称为腺样体面容the child has an elongated face with dull expression prominent open mouth for breathing and crowded upper teeth and hitched up upper lip这些孩子有一张拉长的脸,表情呆滞,突出的张着呼吸的嘴,上面有密集的牙齿,上唇上翘nose gives a pinched in appearance due to disuse atrophy of a lane easy鼻子因废用而萎缩,容易使外观变皱hard palate in these cases is highly arched as the molding action of the tongue on palate is lost because the child has to always keep the mouth open for breathing硬腭在这种情况下是高度拱形的,因为舌头在上颚上的塑造作用消失了,因为孩子必须一直保持嘴巴张开来呼吸2 pulmonary hypertensionin long standing nasal obstruction due to adenoid hypertrophythe oxygen reaching lungs is decreased so the blood pressure in pulmonary artery increases to carry the oxygen needed for tissues of body which can cause pulmonary hypertension and corpulmonale2肺动脉高压 由于腺样体肥大引起的长时间鼻塞使到达肺部的氧气减少,从而使肺动脉内的血压升高以携带机体组织所需的氧气,从而引起肺动脉高压和肺心病diagnosis诊断examination of post nasal space is possible in some young children and an adenoid mask can be seen with a mirror在一些儿童中是可以借助鼻咽镜检查后鼻孔的腺样体的soft tissue lateral radiograph of nasal pharynx will reveal the size of adenoids and also the extent to which nasal pharyngeal airspace has been compromised鼻咽X线侧位片将显示腺样体的大小以及鼻咽部残余的空间detailed nasal examination should always be conducted to exclude other causes of nasal obstruction应始终进行详细的鼻腔检查,以排除引起鼻阻塞的其他原因
喉的结构及功能
咽的结构及功能
鼻的结构及功能2
鼻的结构及功能1
耳的结构及功能2
下咽癌和喉癌
Early Embryonic Facial Development安徽中医药大学第一附属医院耳鼻喉科金龙早期胚胎面部发育The facial features of the human embryo develop rapidly very early on in pregnancy beginning around the 4th week after conception.从怀孕后第4周开始,人类胚胎的面部特征在怀孕的早期就迅速发展Many of the structures of the face originate from a group of cells called Cranial Neural Crest Cells.面部的许多结构都来自称为颅神经嵴细胞的一组细胞。These cells move in a distinct pattern from the neural tube located in the back of the embryo to create the various structures of the face.这些细胞以与位于胚胎后部的神经管不同的模式运动,从而形成面部的各种结构。Aberrations in the formation or behavior of these cells are the main causes of abnormalities in the head and face.这些细胞的形成或行为异常是头部和面部畸形的主要原因。During the first three days of development,the fertilized ovum, or egg, is located in the Fallopian tube.在发育的前三天,受精卵或卵子位于输卵管中。As it travels down the tube, it undergoes rapid divisions to form a cluster of cells called the morula.当它沿输卵管下行时,它经历快速分裂形成一簇细胞,称为桑葚胚。These cells then organize themselves to form the blastocyst and by the end of week 5,the fully formed blastocyst comes into contact with the uterine wall for implantation.这些细胞组织起来形成胚泡,在第5周结束时,完全形成的胚泡与子宫壁接触,准备着床。During the second week of development, the inside of the blastocyst known as the embryoblast,becomes two layers, the hypoblast and the epiblast layers.在发育的第二周,胚泡内的成胚细胞分为两层:内胚层和外胚层。Together these layers form oval-shaped disc-like structure.这些层合在一起形成了椭圆形的圆盘状结构。In the third week development,a streak is created on the surface of the epiblast,during which time, the cells of the epiblast detach and migrate.在发育的第三周,外胚层表面形成一条条纹,在此期间,外胚层细胞分离和迁移。These migrating cells create three layers, the ectoderm, mesoderm and endoderm layers,which go on to contribute cells to form all the tissues and organs in the human body.这些迁移的细胞创造了三层,外胚层、中胚层和内胚层,它们继续贡献细胞来形成人体的所有组织和器官。In the third to fourth weeks of development a cord called the notochord is formed.在发育的第三至第四周,脊索形成。This induces the cells in the overlying ectoderm to thicken forming a region called the neural platealong the back at the embryo.这导致覆盖外胚层的细胞增厚,形成一个沿着胚胎背部的神经板。The edges of the neural plate elevate to form the neural folds, that eventually fuse to form the neural tube神经板的边缘升高以形成神经褶皱,最终融合形成神经管During this process neural crest cells are formed along the entire length of the tube at the tip of the folding neural folds.在这一过程中,神经嵴细胞沿着整个管的长度在折叠神经褶皱的尖端形成。Neural crest cells formed from the head, or cranial region, are called Cranial Neural Crest Cells, or CNCC's由头部或颅区形成的神经嵴细胞称为颅神经嵴细胞,简称CNCCThese cells multiply and soon start migrating over long distances in distinct paths,from the back of the embryo towards the front of the embryo.这些细胞繁殖并很快开始以不同的路径长距离迁移,从胚胎的背面迁移到胚胎的前面。Once they arrive at their target destinations in the facial regions,CNCC's further develop and mature and ultimately contribute to a substantial amount that the structures in the head and neck region such as bones, cartilage and nerves.一旦它们到达了面部区域的目标目的地,CNCC就会进一步发展和成熟,并最终对头颈部的骨骼、软骨和神经等结构做出大量贡献。Growth migration and subsequent differentiation of CNCC's are critically important for proper development of the normal structures of the facial region.生长迁移和CNCC的后续分化对面部正常结构的正常发育至关重要。Soon after the CNCC's reach their final destination,the facial structures begin to take shape externally.CNCC到达目的地后不久,面部结构开始在外部形成。By the fourth week of development the embryo is characterized by five facial swellings,the frontonasal prominence and the paired maxillary and mandibular prominences these structures are formed in part from the migration and proliferation of the CNCC's from different regions of the neural tube.在发育的第四周,胚胎的特征是5个面部隆起,额窦突出和成对的上颌和下颌突起,这些结构部分是由来自神经管不同区域的CNCC的迁移和增殖形成的。In a five-week-old embryo the nasal placodes which will go on to become the olfactory system and the optic placodes which will become the lenses of the eyes will form.在一个五周大的胚胎中,嗅基板将形成嗅觉系统,而视觉基板将形成眼睛的晶状体。in addition the maxillary and mandibular prominences enlarge and grow forward and towards the middle eventually giving rise to the upper and lower jaws respectively.此外,上颌和下颌的突起扩大并向中间生长,最终分别形成上颌和下颌。In a six-week-old embryo the two mandibular prominences fuse to form the lower jaw At this point the outline of the mouth is visible.在一个六周大的胚胎中,两个下颌的突起融合在一起形成了下颌,这时可以看到嘴的轮廓。In the seven-week-old embryo the maxillary prominences grow and fuse to form the border of the nostril and the upper lip.在7周大的胚胎中,上颌骨突起生长并融合形成鼻孔和上唇的边界。Merging of the maxillary and mandibular prominences forms the cheeks and the corners at the mouth.上颌骨和下颌的突起形成了脸颊和嘴角。The philtrum of the upper lip and palate are also created at this time人中和上腭也在这个时候形成In this flurry of activity in the first seven weeks after fertilization the five facial prominences give rise to the formation of the forehead and sides of the face,middle and sides of the nose, the philtrum, the upper lip the palate and the lower jaw.在受精后的前七周,在这一连串的活动中,五个面部隆起形成了前额和脸的两边、鼻子的中间和两边、人中、上唇、上颚和下颌。By the seventh week of human embryonic development,most of the facial structures can be observed.在人类胚胎发育的第七周,可以观察到大多数面部结构。In the next few months of development the initial cartilaginous skeleton of the face is replaced by bone and there is an overall increase in shape and size of the different structures of the face.在接下来几个月的发育过程中,面部最初的软骨会被骨骼所取代,面部不同结构的形状和大小也会整体增加。From childhood to adulthood the face continues to develop through further growth and remodeling.从童年到成年,脸部会通过进一步的成长和重塑而不断发展。
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中西医对突发性耳聋病因的认识还在不断完善之中,其病因可能是单因素致病也有可能是多因素致病。西医对其病因认识主要是:(1)供血障碍;(2)毛细胞离子通道障碍伴细胞功能障碍;(3)神经突触病变引起神经介质的功能障碍;(4)传出调控失常;(5)血管纹细胞的离子通道病变引起内淋巴电解质异常,有时出现膜迷路积水;(6)炎性病变;(7)不明原因的病理生化和病理生理改变。详见:为什么我会得突发性耳聋——现代医学认识中医认为耳聋不外虚实两证:实证多为:外感六邪、肝气上逆、痰火蕴结、痰瘀互结、气滞血瘀等;虚证有肝肾阴虚、脾胃虚弱、气血亏虚、肾阳亏虚等。虚证为脏腑精气亏虚,不能濡养耳窍所致,虚证发病缓慢、病程较长、病后不易恢复多易形成久聋。耳聋虚证一般为“渐至聋闭”这与现代西医突聋定义短时期内发作不符。详见:为什么我会得突发性耳聋——传统医学认识