الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 90 |  |  |
| | | from | 90 | | |
Abstract
Tracheostomy is a relatively common operation used to maintain a patient’s airway, reduce ventilatory dead space and facilitate access to the lower respiratory tract, by bypassing the upper respiratory tract. The effect of this operation on the chest is well established, but the effect on the nasal mucosa and upper respiratory tract has not been extensively investigated.
Much of the understanding of the effect of nasal airflow on the mucosal epithelium comes from animal experiments in which one side of the nose has been surgically occluded and in humans from laryngectomy patients. In recent studies, the authors concluded that ‘‘inadequate airflow is an important causative factor in nasal & sinus infection’’. The aim of this study was to evaluate the changes in the nasal mucosa of tracheostomized patients as a result of decreased nasal air flow. The evaluation will be done at two and six months post- tracheostomy using endoscopic examination to evaluate visible changes in the nasal mucosa, and methylene blue and saccharine tests to evaluate mucociliary clearance and histopathological examination. 31 Patients were recruited and enrolled through this prospective study at the Department of Otolaryngology–Head and Neck Surgery and intensive care unit ,Menoufia University Hospital spanning the period from December 2014 to September 2016 (5 patients underwent total laryngectomy and 26 underwent tracheostomy for prolonged endotracheal intubation). We found that nasal discharge significantly increased at 2 months after tracheostomy and significantly decreased at 6 months post operatively. For nasal crustations there was a decrease at 2 months post
operatively showing no significance, while at 6 months post operatively there was a significant increase. The color of the nasal mucosa became more pink 2 months after tracheostomy with no significance but at 6 months it became paler with significance. There was no atrophy in the nasal mucosa 2 months post operatively while there was significant mild atrophy noticed at 6 months. There was a significant improvement of the saccharine times and methylene blue movement towards the nasaopharynx 2 months post operatively while there was a significant delay in the saccharine times and methylene blue movement at 6 months. By histopathological examination, There was no change in the epithelium of the nasal mucosa 2 month post tracheostomy while there was high significance atrophy 6 months post tracheostomy when compared with preoperative (P=0.00**). also there was high significant increase in the number of mucous secreting glands 2 months post tracheostomy ( P=0.00) while there was decrease in the number of mucous secreting glands 6 months post tracheostomy when compared with preoperative showing no significance (P1=0.18) . There was significant increase in the number of the inflammatory cells 2 months post tracheostomy (P=0.016) and more significant increase 6 months post tracheostomy (P2=0.008) when compared with preoperative. In our study we concluded that there was increase in the mucociliary clearance of the nose early after tracheostomy or total laryngectomy but with time the mucociliary clearance decreased due to long term effect of air flow deprivation on the nasal mucosa with occurrence of nasal atrophy.