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是不是真的有「空鼻症」( 五 )


The physics of airflow through the nose is complex and still not fully understood, though a study is underway at Ohio State University to better understand it. OSU’s Dr. Alex Farag and engineer/researcher Kai Zhao are developing 3D models to perform virtual nasal surgeries on patients before an actual surgery. By taking measurements and running models, they hope to see how the surgery could affect nasal airflow, which could lead to more-informed surgeries and fewer complications.
经过鼻腔的气流物理学是复杂的，而且到现在也没有被全部弄清楚，通过一个在俄亥俄州立大学的进行中的研究可以更好得了解它。俄亥俄州立大学的Alex Farag医生和工程师/研究者Kai Zhao 发明了一个3D模型，可以在实际手术之前在病人身上进行模拟手术。在经过测量和运行模型后，他们希望可以看到手术是如何影响鼻腔气流的，这可以领导更加定向化的手术和更少的并发症。
It could also be that both the airflow and mucosal/sensory theories are simultaneously true. For now, Houser and Stanford’s Nayak use cotton pledgets in the nose to help diagnose patients who complain of ENS symptoms. When the piece of cotton is inserted correctly, a patient with ENS will often feel radical improvement.
也有可能气流论和 粘膜/传感器的理论都是正确的。到目前为止，Houser 和斯坦福的Nayak用医用脱脂棉塞入鼻腔来帮助那些受空鼻症困扰的人。当医用棉塞入正确的时候，空鼻症的病人通常会感受到彻底的改善。
And then there’s the psychological mystery. Nayak says the ENS patients he has treated not only breathe better, they’re happier. “Anxiety, depression — all of these are off the charts for the initial patient with true empty nose syndrome,” Nayak says. He and his team are still trying to understand why that simple tubular structure seems to be essential to a proper sense of well-being for some people.
有一些心理学上的疑问。Nayak 说他治疗后的病人不仅仅呼吸得好了，而且也高兴多了。“对当初来就医被确诊为空鼻症的患者，他们的焦虑，抑郁症——所有的这些问题的程度在图表的反馈上都降低了，”Nayak 说道。他和他的团队仍旧试图尝试去理解为什么这种简单的管状结构，对一些人的舒适度这么重要。
Houser can’t fully explain the relationship between mental health and ENS either. “I’ve wondered, which came first?” he says. “Were they that way, and therefore they’re more prone to nerves healing poorly after surgery and developing empty nose? Or is it the empty nose that made them so nervous and worried? I can say for sure that I’ve seen nervous, worried patients, and I implant them, and they do appear more at ease after they’re implanted. When I can get their breathing better, they’re less anxious.”
Houser并不能全面得解释精神问题和空鼻症的关系。“我在想哪个问题先来的？”他说。“如果按照他们所说的一样，因此他们更易于在手术恢复差的时候发展为空鼻症？又或者是空鼻症本身让他们如此紧张和担心呢？（但是，译者注）我可以保证我见过紧张，焦虑的（空鼻症）病人，我给他们移植管之后，但是他们的确变现得轻松多了。当我使他们可以更好得呼吸时，他们的焦虑会少些。
In a 2012 study in France, doctors treated a 37-year-old man with ENS symptoms who left his job and all social relationships. He spent most of his time alone in his bedroom with a humidifier. After doctors treated him with cognitive therapy and an antidepressant, many of his symptoms cleared up. “Treating ENS as a somatic symptom disorder might constitute a first-line safe alternative to surgical or even medical treatment,” the authors say.
在法兰西的一个2012年的调查，医生们治疗了一个37岁的男空鼻症患者，他放弃了他的工作和所有的社会关系。他把他所有的时间放在了一个带有加湿器的卧室里。在医生们对他进行了认知疗法和抗抑郁治疗后，他的许多症状消失了。“把空鼻症当做身体状态失调（来治疗），可能可以作为替代外科手术，甚至医疗治疗的第一安全方法，”作者们这么说。
是不是真的有「空鼻症」
“What we’ve seen in a lot of other chronic diseases is, each person’s perception of how bad they are is also dependent upon their general psychological health,” says UVA’s Payne. “People with poor coping mechanisms, with underlying depression or anxiety disorder — they are more likely to have symptoms that seem to take over their lives. That’s just not a normal response to chronic disease. And so you scratch your head, because as a physician, it’s the hardest thing trying to understand when are symptoms real, when are symptoms real but exacerbated by underlying psychological issues, and when are symptoms completely psychological.”
“我们看到的就像很多其他心理疾病一样，每个人的对于他们的好坏程度的判断也是取决于他们的总体的心理健康，”UVA的Payne说道。“那些有着不良应对机制的人，那些潜在的抑郁或者焦虑的人 —— 他们更有可能产生那些毁掉他们生活得症状。这对心理疾病来说并不是一个简单的回答。因为作为一个医生，当你在搜刮你大脑的时候，尝试着要去理解这个是最困难的，到底什么时候症状是真的，什么时候这些症状是真的但是被潜在的心理问题恶化的时候，什么时候全部的症状完全是心理上的。”
One ENS patient I spoke with, 52-year-old Sheila O’Shea, has become an informal counselor for suicidal ENS sufferers and sometimes fields late-night phone calls from them. She finds the emphasis on depression and mental health issues associated with ENS patronizing and insulting. “We’re sane people going through an insane situation," she says. "Have you ever been stuck underwater, and you couldn’t make it to the surface fast enough? That panic you have? We have that all day long.”
我跟一个空鼻症的病人交谈过，52岁的Sheila O’Shea，已经成为一个资深的心理咨询家为那些想要想要自杀的空鼻症患者服务，有的时候他们会夜里打电话过来。她认为把在抑郁和心理健康问题，联系到空鼻症上面是傲慢而又污蔑人的。“我们是神智健全的人却在经历一个非常疯狂的处境，”她说。“你有经历过不能尽快回到水面的时候在水下不能动吗？你有经历过那种痛苦吗？我们整天都承受着这样的痛苦。”
She, like Brett, insists the accompanying mental condition is different from depression. “It’s as if you’re looking at the world through a big piece of Plexiglas. You can see everything and hear everything, but every experience is flat,” she says. “Depression messes with perception. Here, nothing is wrong with our perception. I’m not depressed.”
她就像Brett一样，坚持着伴随他们的心理状况是不同于焦虑的。“就像你在透过一个巨大的树脂玻璃看着这个世界。你可以看见和听见所有的东西，但是一切的经历却是单调的，”她说。“抑郁症会混乱感知能力。这里，我们的感知能力没有任何问题，所以我没有抑郁症。”
是不是真的有「空鼻症」
Brett Helling’s older brother, Paul, once gave him a mounted deer head he’d fished out of the trash. As a joke, Brett put the deer head in his car and drove around town with it for months. The first time Sean Gardner saw it, they were drinking beers on a Saturday afternoon in a friend’s living room. “Suddenly, this deer is banging its antlers against the window,” Sean says. “We’re all freaking out, like, ‘Oh my God!’ I run over to the side and I see Brett with this big smile. And he’s like, ‘Yeah, you just got deer-burned.’ That became his new thing.”
但是 Brett Helling 的兄长，Paul, 有一次给了他一个装饰好的鹿头，他从垃圾里面捡来的。 作为一个玩笑，Brett把鹿头放在他的车里并且开着它在镇里开了数个月。第一次Sean Gardner 见到它的时候，是在一个周六的下午，他们在一个朋友的起居室喝着啤酒。“突然，这只鹿用它的鹿角猛击着窗户，”Sean 说道。“我们都吓坏了，就像，‘我的上帝！’我马上跑到一遍，然后我看到了Brett带着他的大大的笑脸。表情就像, ‘哈哈，你刚刚被鹿吓到了。’这渐渐变成了他的新事。”
“He deer-burned me in the kitchen once,” Mollie Gardner says, http://laughing.In the day or two following Brett’s death, Sean and Mollie wondered aloud, hopefully, if the whole ordeal was just another deer burn — the ultimate fake-out. But they knew that was wishful thinking. Once friends and family began arriving from out of town, Carol gave Sean and a few other friends one of several typed-in-advance notes Brett had left in his car near the bridge. There was also a handwritten note for the police.
“他又一次在厨房把我吓到了一次，”Mollie Gardner 说着，笑着。在Brett死后的一两天内，Sean 和Mollie 非常怀念他，他们希望着这整个悲剧只是另一个鹿头恶作剧 —— 无尽的恶作剧。但是他们知道这仅仅是的愿想罢了。当朋友们和家人从外镇来到他自杀的地方的时候，Carol 给Sean和一部分其他的朋友一份Brett提前打印好的遗书，Brett把它留在了停在桥旁边的车里面。那里也有一份手写的遗书，是留给警察的。
“Suffering from empty nose syndrome (aka: sinus surgery gone wrong) and cannot suffocate any longer,” he’d scribbled with a Sharpie. “Please recognize this for what it really is and not just pass it off as ‘depression.’ ... ENT doctors need to stop taking away perfectly good lives like mine was. This disease is very real, is untreatable, yet 100% preventable. Awareness is needed to make ENS a household name so people will stop being talked/pushed into very dangerous ‘routine’ surgery. We will continue to lose good, happy, productive, and healthy people to this disease otherwise. It took everything from me. I am not the last. www.emptynosesyndrome.org.
“我承受着空鼻症的痛苦（aka:鼻窦手术出错）并且再也不能忍受窒息感了，”他用变形的字体潦草得写下。“请认识到这个病是真实的，不要仅仅把它诊断为‘抑郁症’来忽略它。…… 这个疾病是真实的，是无法医治的，也是100%的可以预防的。意识到把空鼻症作为一个日常的民资，这样子人们才会停止被讨论/推动进一个非常危险的‘常规’手术中。我们不然我们将会持续得将善良的，高兴的，有生产力的，和健康的人丢到这个疾病里面。他把我的一切都夺走了，然而我并不是最后一个。
“P.S. Mom, I’m sorry! I held on as long as I could for you.”
“附言：妈妈，我非常抱歉！我已经为你坚持得尽可能得久了。“
The other notes went into more detail. One was a nearly 30-page script that Brett instructed Sean and three other friends to read at a memorial held at Natalie’s. The script had stage directions and specific instructions from Brett about who should read each section and even how long to pause so that certain jokes would land. It’s long-winded and rambling — angry at times (“I was ultimately killed by Empty Nose Syndrome and a salesman in a long, white jacket”) and darkly funny at others (“I felt like I was splashing around in the ocean and when Hasselhoff finally pulled up to rescue me, he just slapped some sunscreen on me and drove away on his little Jet-ski”). Brett had a way with words, but it was emotionally torturous for Sean and others to read those words on a stage in front of everyone.


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