Chronic rhinosinusitis is a common disease, because it is mostly accompanied by rhinitis, so it is also called chronic rhinitis sinusitis, which is mostly used at present, and its treatment is more confusing. The Chinese Medical Association Branch of Otolaryngology Head and Neck Surgery has issued guidelines for the diagnosis and treatment of chronic rhinosinusitis in order to standardize the treatment plan.
Chronic rhinosinusitis is a chronic inflammation of the mucous membrane of the nasal cavity and sinuses, with nasal symptoms lasting more than 12 weeks and symptoms not completely relieved or even aggravated.
I. Symptoms
1. primary symptoms: nasal congestion, mucous, purulent nasal discharge.
2.Secondary symptoms: head and face swelling and pain, reduced or lost sense of smell.
The diagnosis is based on the above two or more related symptoms, among which nasal congestion, mucous and purulent nasal discharge must be one of the main symptoms.
Examination
1. Nasal examination: mucopurulent secretions from the middle nasal tract and olfactory fissure, congestion and edema of the mucosa of the middle nasal tract or the presence of nasal polyps.
2, imaging examination: CT scan shows sinus-oral nasal tract complex or nasal tract mucosal lesions. This is currently the predominant diagnostic method.
Clinical classification 1. chronic rhinosinusitis (without nasal polyps) 2. chronic rhinosinusitis (with nasal polyps)
III. Drug treatment.
1, intranasal local glucocorticoid spray, a course of not less than 12 weeks; systemic glucocorticoids: only for severe, recurrent nasal polyps, you can take oral prednisone tablets (or prednisolone), a course of 5-0 days, up to 14 days (taken once at 7 am on an empty stomach). Systemic or intranasal glucocorticoid injections are not recommended; specific drugs include co-corticosteroids, ryanodine, endocannabinoids, tretinoin, etc. (all are nasal sprays, just choose one).
2, macrolides (such as clarithromycin, erythromycin, etc.), which have anti-inflammatory effects, are recommended to be taken orally in small doses (1/2 of the conventional antibacterial dose) for a long time, with a course of treatment of not less than 12 weeks. Clarithromycin tablets are currently preferred, 0.25 orally, 1/day for 1-3 months, with monthly review of liver function and caution or addition of liver protectors for abnormal liver function.
For acute rhinosinusitis or acute exacerbation of chronic rhinosinusitis, penicillins, cephalosporins, sulfonamides, macrolides, fluoroquinolones and other sensitive drugs can be used in regular doses, with a course of treatment not exceeding 2 weeks. Amoxicillin clavulanic acid potassium injection is currently the preferred treatment for sedation. Topical antibiotics for the nasal sinuses are not recommended.
3, decongestants, the main role of nasal spray can make the nasal cavity ventilation, reduce nasal congestion symptoms, in order to facilitate the flow of pus nasal sinus, such as ephedrine nasal drops, Daphnin nasal spray, Norton nasal spray, etc., these are not very suitable for pediatric patients under 6 years of age (children can consider using physiological seawater), can be considered for a short period of time (generally not more than 7 days), nasal congestion can be used for 7-10 days;.
4, the main function of mucus promoter is to dilute the mucus, make the pus nasal cavity thin, and improve the cilia activity on the surface of nasal mucosa to promote the discharge of nasal mucus, drugs such as standard myrtle oil (trade name Genotone), aminocampus enteric capsule (trade name Chenaud), Mucosolvan, etc., Xian Lu Bei, choose one, use it for 1-2 months.
5.For patients with allergic reactions, such as frequent sneezing and runny nose, you can take the 2nd generation or new antihistamines orally. For example, loratadine tablets, desloratadine tablets, cetirizine tablets, etc., choose one to take for a short time (10-15 days).
6.Some Chinese medicines have certain effect on improving the symptoms of chronic rhinosinusitis, and should be chosen according to the principle of evidence-based treatment. Specific drugs include Nasal Abyss Shu Oral Liquid, Nasal Abyss Tongkou Granules, Tongkou Rhinitis Tablets, Rhinitis Kang Tablets, Rhinitis Tablets, Xiangju Capsules and other Chinese medicines, choose one to take for 15-30 days.
7. Daily saline or hypertonic saline rinses the nasal cavity, the main function of which is to rinse out the pus nasal mucus in the nasal cavity. Adults, children over 3 years old and pregnant women can use it, it is safe, effective and non-irritating. It can be used for a long time, more often when there is a lot of pus nasal discharge, 3-4 times a day, and once every 2-3 days when there is little pus nasal discharge. (First use 0.9% saline, then gradually increase the concentration to 2%~3%) for 3-6 months.
IV. Surgical treatment.
Indications: Chronic rhinosinusitis can be treated surgically if one of the following conditions is present.
(1) obvious anatomical abnormalities affecting the sinonasal complex or the drainage of each sinus (e.g. vesicular middle turbinate, deviated nasal septum, etc.)
(2) Nasal polyps affecting the sinonasal complex or the drainage of each sinus.
(3) Unsatisfactory improvement of symptoms after 3 months of standard drug treatment.
(4) Cranial and orbital complications.
It is very important to perform regular postoperative cavity cleaning after discharge, not all is done after the surgery is completed, but only 60-70% of the whole disease treatment is completed after discharge. If the postoperative review is standardized, recurrence can be basically eliminated, and even if there are small recurrences and other problems, they can be dealt with during the review process. The frequency of review is frequent in the early postoperative recovery period, and the number of reviews can be significantly reduced in the later recovery period. Generally, it is a review once and then about the next review time.
Post-surgical drug therapy is based on the same principles as the above-mentioned standardized drug therapy for chronic rhinosinusitis for 3 months before surgery. Anti-inflammatory reaction medication for 1-3 months (half amount of clarithromycin); intranasal topical glucocorticoid spray for a course of not less than 3 months; decongestants for 7-10 days after surgery; mucus pro-discharge agents for 2-4 weeks; an antihistamine chosen for a short time (10-15 days) for patients with allergic reactions; some herbal medicines chosen for about 15 days; daily saline or hypertonic saline rinses of the nasal cavity.