Chronic rhinosinusitis and sinusitis, nasal polyps are common and frequent diseases of rhinology. The incidence of nasal polyps is 1-2%, while the incidence of chronic rhinosinusitis is as high as about 22%, which can be encountered in almost all of a person’s life. Both account for about 1/2 of the patients in ENT outpatient clinics.
How is rhinosinusitis caused?
Chronic rhinosinusitis can be caused by four factors.
Infection (bacteria, viruses, mycobacteria)
Various viruses, bacteria, and mycobacteria can be the causative agents of chronic rhinosinusitis, but mixed infections are common.
The common causative agents of acute sinusitis are: streptococcus, staphylococcus, catarrhococcus, diplococcus pneumoniae, bacillus influenzae, etc.
Viruses: rhinovirus, adenovirus, influenza virus, etc. Can be complicated by mycobacterial infections.
Common diseases that can cause chronic rhinosinusitis include.
1, acute rhinitis commonly known as “cold”, “cold”, often part of the upper respiratory tract infection, improper treatment can lead to mucosal lesions in the sinuses, leading to chronic rhinosinusitis.
2, odontogenic infection or chronic tonsillitis, can be secondary to sinusitis.
3, sinus trauma can occur bacterial infection.
4.Acute infectious diseases are often accompanied by acute upper respiratory tract infections or bacteraemia in the early stages leading to sinusitis.
Irritants
Air pollution, smoking and chemical irritants (such as insecticidal sprays, disinfectants and household cleaners) cause swelling of the mucous membrane of the nasal cavity and sinuses and block the narrow passage between the nasal cavity and sinuses, leading to bacterial growth and sinusitis.
Allergic factors
When the mucous membrane of the nasal cavity has a metamorphic reaction, the mucous membrane of the nasal cavity and sinuses becomes edematous and polyps form over time, blocking the sinus opening and obstructing the ventilation and drainage of the sinuses, making them susceptible to bacterial infection and sinusitis.
Anatomical abnormalities
There are frontal sinuses, septal sinuses, pterygoid sinuses and maxillary sinuses. The anatomy and structure of each sinus are different and adjacent to each other. Once the sinus opening is narrowed or blocked, such as deviated nasal septum, enlarged turbinates, and thickened mucosa, the ventilation and drainage of the sinus cavity is affected and pus accumulates or becomes chronic sinusitis, and inflammation of one sinus can easily involve the neighboring sinuses.
Symptoms of nasal-sinusitis.
1, nasal congestion: sinusitis when the nasal mucosa is congested and swollen, nasal secretions accumulate or nasal polyp formation, or nasal septum deviation, turbinate hypertrophy caused.
2, runny: sinusitis when the inflammation of the mucous membrane secretion increased, depending on the severity of the lesion can be mucous, mucopurulent or pure purulent, secretions can flow to the nasal cavity forward blowing or to the posterior nostril flow into the nasopharynx karate out.
3.Headache: When inflammation occurs in the sinuses located in the head and face, the inflammatory stimulation or neurological reflexes cause pain in one or more places in the head and face.
4.Sniffing disorder: due to inflammation of the mucous membrane in the olfactory region of the nasal cavity or pus or polyps obstructing the olfactory groove.
5.Fever: generally low fever, acute phase or acute attack may be high fever.
Diagnosis
It is easy to diagnose based on history and speculum examination, but the diagnosis must be made by CT, nasal endoscopy and other examinations to clarify the following questions: What is the extent of sinus inflammation? Are there anatomical abnormalities? Is there a neoplasm such as nasal polyp or turbinate polyp-like? Is there a mycotic infection?
Treatment
The main treatment includes conservative medical treatment and surgical treatment, which is mainly controlled by medication. Today, surgical treatment is mainly introduced. If anatomical abnormalities, neoplasia such as nasal polyps, or mycobacterial infection are found, surgery should be the first choice.
Modern surgical treatment method – Functional Endoscopic Surgery (FESS)
Functional nasal endoscopic surgery is a minimally invasive technique that uses a good nasal endoscopic visualization system and a powerful nasodynamic system.
This technology was developed abroad in the 1970s and introduced to China in the mid-1980s. The first hospital to introduce this equipment was in Tianjin, and it started to emerge in China in the early 1990s, and soon developed into a mature technology that was promoted nationwide.
Functional nasal endoscopic surgery is a milestone leap and revolution in traditional nasal and sinus surgery. It is a very delicate surgical method. Under local or general anesthesia, the nasal endoscope can look directly into the deep and delicate structures of the nasal cavity and sinuses to completely remove lesions (e.g. nasal polyps, narrow channels between the nasal cavity and sinuses) and correct anatomical abnormalities.
Since the theoretical basis of FEES surgery is completely different from that of traditional nasal surgery, through small-scale or limited surgery, the nasal cavity and sinus ventilation and drainage are reestablished, thus improving and restoring the morphology and physiological function of the nasal cavity and sinus mucosa, and relying on the recovery of the nasal cavity and sinus’s own physiological function to resist the attack of external pathogenic factors, so as to treat the lesion and prevent recurrence.
With the continuous standardization of functional nasal endoscopic surgery, the understanding of the pathogenesis of chronic rhinosinusitis has been improved, and the efficacy has been significantly improved. It can be said that the recurrence rate after traditional surgery is 80%, while the recurrence rate of FESS surgery is reduced to about 20%.
The following is a comparison between traditional surgery and functional nasal endoscopic surgery
1.Traditional surgery :
Nasal polyps sinusitis separate multiple surgeries, removal of middle turbinate, removal of sinus mucosa, opening of maxillary sinus requires a labiogingival incision, chiseling the anterior wall of maxillary sinus, and opening of the lower nasal tract.
2.Functional nasal endoscopic surgery:
In the case of sinusitis with nasal polyps, only one operation is required, preserving the middle turbinate, preserving the sinus mucosa, enlarging the natural opening of the maxillary sinus, opening the lower nasal tract without a window, without making a lacrimal incision and chiseling the anterior wall of the maxillary sinus.