Chronic rhinosinusitis is a common disease, also known as chronic rhinosinusitis because it is often accompanied by rhinitis, 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, where nasal symptoms persist for more than 12 weeks and are not completely relieved or even worsened. Diagnosis 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 cavity examination: mucopurulent secretion from middle nasal tract and olfactory fissure, congestion and edema of middle nasal tract mucosa or nasal polyps. 2.Imaging examination: CT scan shows sinus-oral nasal tract complex or nasal tract mucosal lesions. This is the most important diagnostic method at present. Clinical classification 1, chronic rhinosinusitis (without nasal polyps) 2, chronic rhinosinusitis (with nasal polyps) I. Drug therapy: (1) intranasal local glucocorticoid spray, a course of not less than 12 weeks; systemic glucocorticoids: only for severe, recurrent nasal polyps, can be oral prednisone tablets (or prednisolone), a course of 5 to 10 days, up to 14 days (once taken at 7 am on an empty stomach). Systemic or intranasal injection of glucocorticoids is not recommended; specific drugs are co-corticosteroids, ryanodine, endosulfan, tretinoin, etc. (all nasal sprays, choose one can) (2) macrolides (such as clarithromycin, erythromycin, etc.), with anti-inflammatory effects, small doses (1 / 2 of the conventional antibacterial dose) are recommended for long-term oral administration, a course of treatment of not less than 12 weeks. Currently preferred clarithromycin tablets, 0.25 oral, 1/day, with 1-3 months, monthly review of liver function, liver function abnormalities caution or add liver protection drugs; for acute rhinosinusitis or chronic rhinosinusitis acute exacerbation, penicillins, cephalosporins, sulfonamides, macrolides, fluoroquinolones and other sensitive drugs can be used, conventional dose, the course of treatment is not more than 2 weeks. Amoxicillin clavulanic acid potassium injection is currently the preferred treatment for sedation. Not recommended for local use of antibiotics in the nasal sinuses; (3) decongestants The main role of nasal spray can make the nasal cavity ventilated, reduce the symptoms of nasal congestion, in order to facilitate the flow of pus nasal discharge in the nasal sinuses, 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) For those with severe nasal congestion, it can be used for 7-10 days. (4) Mucus promoter The main function is to thin the mucus, make the pus nasal cavity in the nasal cavity become thin, and can improve the nasal mucous membrane surface cilia activity, promote the discharge of nasal mucus, drugs are standard myrtle oil (trade name Genotone), aminocampus enteric capsule (trade name Chenaud), Mucosolvan, etc., choose one, with 1-2 months. (5) For patients with allergic reactions, such as frequent sneezing and runny nose, you can take 2nd generation or new antihistamines orally. For example, loratadine tablets, desloratadine tablets, cetirizine tablets, etc., choose one for a short period of time (10-15 days) (6) Some Chinese herbal medicines are effective in improving the symptoms of chronic rhinosinusitis, and should be selected 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 is to rinse out the pus nasal snot 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. Second, surgical treatment: Indications: Chronic rhinosinusitis can be treated surgically if one of the following conditions: (1) obvious anatomical abnormalities affecting the sinus orifice nasal tract complex or the drainage of each sinus (such as 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 (this is very, very critical). (4) Development of cranial and orbital complications. Perioperative management: Perioperative management is centered on surgery and in principle should include pre-hospital preparation, hospitalization (preoperative preparation, postoperative recovery), post-discharge review and medication administration. Pre-hospitalization preparation: After 3 months of standardized drug treatment (if the condition is cured after 3 months of treatment, surgery is not necessary. If it is not cured, the condition will be very significantly improved after treatment, the scope of surgery becomes smaller, the intraoperative bleeding is significantly reduced, the risk becomes smaller and the postoperative recovery is shortened, and the cost is reduced, which is the significance of 3 months of standardized treatment). Adjustments to control systemic diseases, such as diabetes, hypertension, heart disease, etc., were started 2 weeks before admission. If you have oral anticoagulants and other medications, please consult the relevant doctor in advance. Start IV antibiotic therapy and systemic glucocorticoid therapy (prednisone tablets, 20-30 mg orally once a day at 7 am for 5 days) 5 before admission. And of course the aforementioned related treatment cannot be stopped. During hospitalization: After admission, continue the same pre-admission sedative anti-inflammatory treatment until the start of surgery. Pre-operative tests will be completed and a surgical plan will be drawn up. This part will be taken care of by the experienced bedside physician. Half an hour before surgery, sedative drugs and hemostatic drugs will be injected, and half an hour before surgery, antibiotics will be administered. After surgery, anti-inflammatory and hemostatic symptomatic treatment will continue. Generally, the nasal stuffing will be extracted the next day after surgery. Nasal saline rinsing can be started after the extraction of nasal stuffing. After the operation, the patient will be discharged from the hospital in 5-7 days. After discharge from the hospital, insist on nasal saline rinsing (see previous section), the main function of which is to rinse out the blood and snot crusts from the nasal surgery site and to prevent the nasal cavity from drying out. Rinse well, and after 20 minutes nasal spray glucocorticoid spray (spray drug twice a day). More rinsing in the short term after surgery and less rinsing in the long term for good recovery. 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 has been completed after discharge. If the postoperative review is standardized, recurrence can be basically eliminated, and even if there are small recurrence 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. Usually it is a review once and then about the next review time. Post-surgical drug therapy is based on the same principles as the standardized drug therapy for chronic rhinosinusitis for 3 months before surgery described above. Anti-inflammatory reaction medication for 1-3 months (half amount of clarithromycin); intranasal local 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; for patients with allergic reactions, an antihistamine selected for a short time (10-15 days); some Chinese herbs selected for about 15 days; daily saline or hypertonic saline rinses of the nasal cavity for 3 – 6 months.