Chronic rhinosinusitis (CRS) is a chronic inflammation of the mucous membrane of the nasal cavity and sinuses, with nasal symptoms lasting more than 12 weeks without complete resolution or even worsening of symptoms. CRS is classified into two basic types of chronic rhinosinusitis (without nasal polyps) and chronic rhinosinusitis (with nasal polyps) according to the presence or absence of nasal polyps. The main symptoms include nasal congestion, mucous and purulent nasal discharge as well as head and facial swelling and pain, and reduced or lost sense of smell.
Medications as the main treatment modality for CRS are glucocorticoids (local and systemic hormones), macrolide anti-inflammatory drugs, antimicrobials for acute attacks of chronic rhinosinusitis; also decongestants, mucus promoters, systemic antihistamines, and some herbal medicines, and nasal irrigation also provide good relief. Although most CRS can be controlled, however, surgery is needed to correct certain patients who are not sensitive to medication and when the chronic course of the disease continues to develop with ineffective medication control.
Indications for surgery for chronic rhinosinusitis
The surgical treatment of CRS is mainly based on functional endoscopic sinus surgery (FESS) and can be performed in one of the following cases.
1. Significant anatomical abnormalities affecting the sinus-oral nasal tract complex or the drainage of each sinus.
2.Nasal polyps affecting the sinonasal complex or the drainage of each sinus.
3.Insatisfactory improvement of symptoms by drug treatment.
4.The appearance of cranial and orbital complications. ‘
Timing of surgery for chronic rhinosinusitis-sinusitis
Sinus surgery can be performed in patients who do not respond well to medication. Transnasal endoscopic sinus surgery (ESS) by itself does not directly treat CRS; the main goal of surgery is to create a structurally sound, well-ventilated, and well-drained local environment for the improvement and recovery of sinus mucosal morphology and function. Therefore, the recommended indications for surgery should be for those who have failed after three months of standardized pharmacological treatment.
The importance of perioperative treatment
1. Preoperative treatment stage: mainly through the judgment of the stage and classification of rhinitis inflammation, the correct comprehensive drug treatment is given. Objectives.
① Reduce unnecessary indications for surgery and narrow the scope of surgery;
②Reducing intraoperative bleeding and making surgical operation more delicate and accurate;
③The control of surgical scope is conducive to smooth postoperative regression;
④The effective control of preoperative inflammation can reduce the aggravation and spread of postoperative inflammation.
2.Surgical treatment stage: good surgical equipment and instruments, fine and accurate surgery by doctors, protection of important structures and mucosa, and minimizing unnecessary tearing are the basis of whether nasal endoscopic surgery can achieve the best treatment effect.
3, post-operative treatment phase: some patients think that after the surgery is done, the surgery can completely cure sinusitis are wrong views. The benign regression of sinusitis requires regular post-operative endoscopic review, nasal irrigation, and medication until the sinus surgery cavity is completely epithelialized.
The postoperative period of sinusitis is divided into three phases: trauma repair period, structural recovery period, and functional recovery period.
① Trauma repair phase: 15-25 days after surgery, the trauma is repaired phase. The first microscopic follow-up should be about 2 weeks after surgery, mainly to clean up the crusts in the nasal cavity and the bloody secretions in the sinus, and to prevent adhesions and narrowing and atresia of the sinus opening. The second follow-up visit should be in 20-25 days, not more than 4 weeks, mainly to check for surgical cavity adhesions and sinus stenosis atresia. Antibiotics, local hormones, nasal irrigation and other treatments during the trauma repair period should be continued, especially for infectious rhinosinusitis, and the use of antibiotics, is still necessary. Postoperative sinus swelling should be controlled by antibiotics, topical hormones and nasal irrigation.
② Structural recovery period (edema reduction and functional recovery period): After trauma repair until swelling subsides, it takes about 3-6 months if the patient actively cooperates with treatment and recovery is smooth. Medication and endoscopic follow-up remain critical during this phase. Most of the patients in this stage nasal ventilation improves, nasal mucus decreases, and some patients regain their sense of smell, this stage is also the stage that patients and physicians take lightly, thinking that sinus inflammation and complete cure, in fact, this thing is the best period of functional recovery, but due to the decline of immunity, “cold” and so on will make the symptoms repeated, the operation cavity The secretion increases and the sinus cavity edema worsens, so the follow-up and medication at this stage are still crucial.
(3) Functional recovery period: From the swelling subsiding to the re-establishment of function, it is also a process from reaching the clinical cure standard to the real functional recovery. It takes about 1-2 years. At this stage, inflammation still has occasional episodes and still requires small doses of medication.
Therefore, standardized medication for sinusitis is used throughout the treatment, and it is wrong to exaggerate the role of medication (that a certain medication can completely cure sinusitis) or to overemphasize that surgery alone can cure sinusitis. We hope that patients will have a correct understanding of sinusitis and appropriate expectations when seeking medical treatment.