I. What chronic sinusitis?
Chronic rhinosinusitis is defined as chronic inflammation of the mucous membranes of the nasal cavity and sinuses, with nasal symptoms lasting >12 weeks without complete resolution or even worsening. The term rhinosinusitis is now used internationally instead of the previous concept of sinusitis, based on the fact that all sinusitis is accompanied by inflammation of the nasal mucosa and that many sinusitis begin with the symptoms of rhinitis first. Rhinitis refers to inflammation that is primarily confined to the nasal cavity. Like acute rhinitis, which is usually called a cold, if not treated thoroughly, it can easily lead to sinusitis, which is chronic nasal-sinusitis over time. In addition, at this stage, nasal polyps are still considered a type of chronic rhinosinusitis.
Chronic rhinosinusitis epidemiological data
Chronic rhinosinusitis is one of the common diseases in otorhinolaryngology, the incidence of which is 8%-15%. Although rhinosinusitis is not a fatal disease, it affects people’s quality of life and can lead to many functional, memory and emotional impairments in addition to nasal congestion and headaches, and should therefore be brought to the attention of clinicians and patients.
Chronic rhinosinusitis causes
Chronic rhinosinusitis is a disease with complex etiology, causing rhinosinusitis has more causes, mainly the following aspects.
1, external factors.
(1) Infectious factors: is the primary factor causing rhinosinusitis, mainly caused by viruses, bacteria, fungi and parasites.
(2) Non-infectious/inflammatory factors.
(i) IgE-mediated allergic reactions.
(ii) Non-IgE-mediated allergic reactions.
(③) Medicated rhinitis.
(4) Rhinitis caused by external irritants.
2.Intrinsic factors.
(1) Genetic factors: mucosal cilia structure and dysfunction
(2) Acquired factors.
(1) Asthma and nasal polyps associated with aspirin hypersensitivity reaction.
(ii) Autonomic rhythm disorders.
(iii) endocrine alterations.
(iv) anatomical variation and obstructive disorders of the sinonasal tract complex.
(v) autoimmune and idiopathic factors.
(vi) immunodeficiencies.
(vii) Allergic and immunological factors.
(viii) Neighboring infection spreading factors.
For children the etiology of rhinosinusitis differs from that of adults and is mainly the result of acute upper respiratory tract infections. The incidence of upper respiratory tract infections in children is higher because of their low immunity to viruses, and then there is the fact that children often live in an environment like school or kindergarten, where they are in close contact with other children, facilitating the spread of infection. Upper respiratory tract infections can lead to swelling of the mucous membranes, which, due to swelling, causes obstruction of the sinus openings and the formation of infections. In children, because the sinuses are smaller and less fully developed, the distance between the mucosal surface and the sinus opening is shorter and, therefore, rhinosinusitis is likely to occur during viral upper respiratory infections.
In summary, chronic rhinosinusitis is mainly the result of the interaction of exogenous factors (environmental factors such as pathogenic microorganisms, environmental pollutants, drugs and trauma) and endogenous factors (local host factors such as acquired mucus cilia dysfunction, intranasal structural abnormalities and hyperplasia; and systemic host factors such as allergic reactions, congenital mucus cilia dysfunction, immune deficiency and neuroendocrine dysregulation). It can be caused by 1 of the endogenous or exogenous factors as the main causative factor, or by a combination of several endogenous and/or exogenous factors. Therefore, the various etiological mechanisms cross and interact with each other. Therefore, the understanding of the pathogenic factors and pathogenesis of chronic rhinosinusitis should be a holistic process.
Prevention and treatment of chronic rhinosinusitis.
Chronic rhinosinusitis can have adverse effects on all parts of the ear, nose and throat, as well as the physiological functions of the trachea, bronchi, lungs and digestive tract, and form foci that can damage other organs and brain power. Sinusitis patients are also a carrier, especially during acute attacks, and are somewhat contagious. Therefore, the actual impact of this disease is not only limited to personal health, but also related to public health.
The following points should be noted in the treatment of rhinosinusitis
① The rhinosinusitis caused by simple bacterial infection can generally achieve better results by conservative treatment such as drugs, and those who are ineffective can consider surgery.
②Rhinosinusitis with allergic factors, in addition to surgery, also need anti-allergic treatment, relying on surgery alone is difficult to avoid the recurrence of rhinosinusitis and nasal polyps.
③Patients who need surgery try to use functional endoscopic sinus surgery to maximize the removal of lesions and restore the physiological function of the nasal-sinus.
Prevention of sinusitis should pay attention to the following points.
①Strengthen the publicity and education work, do not think that hurt wind flow nuisance is trivial, many people often become multi-sinusitis or full sinusitis due to untimely treatment, or turn into chronic.
②Enhance physical fitness, pay attention to temperature changes, and prevent cold and flu.
③Prevent acute infectious diseases such as influenza, whooping cough and measles, especially in childhood.
④Educate children not to put playthings and food into the nasal cavity, and actively treat diseased teeth (mainly upper 4, 5 and 6 teeth) to reduce odontogenic maxillary sinusitis.
⑤ Actively treat rhinitis, deviated nasal septum, improve sinus drainage, hyperplasia of proliferators should also be scraped.
Sinusitis in the acute stage should be actively treated, once it becomes chronic or polyp formation or for full sinusitis, it is difficult to Qin effect with drug therapy alone.