Chronic sinusitis is often clinically classified into three main categories: “chronic sinusitis with nasal polyps”, “chronic sinusitis without nasal polyps” and “chronic sinusitis with complications”, which differ in terms of medication There are different degrees of differences in the principles of treatment and surgery. The treatment of each of the three types of chronic sinusitis is described below. Chronic sinusitis with nasal polyps 20% of patients with chronic sinusitis can be accompanied by nasal polyps, which are formed due to long-term nasal mucosal edema and are mostly located in the olfactory fissure of the middle nasal tract, leading to persistent nasal congestion and olfactory impairment. 1, subjective symptoms light: can first local nasal glucocorticoid treatment, 3 months later review, if the symptoms significantly improved, can continue to maintain treatment, do not need immediate surgery, every 6 months or so review 1. If the symptoms do not improve significantly, review the CT of the paranasal sinuses to observe the obstruction of the sinonasal tract complex and the thickening of the mucous membrane in the paranasal sinuses, and take the corresponding nasal endoscopic surgery treatment. 2, moderate subjective symptoms: local nasal glucocorticoid treatment can be first, the dosage can be increased as appropriate, the same 3 months later review. 3.Severe subjective symptoms: short course of oral hormone with nasal glucocorticoid treatment can be given first for 1 month, if the symptoms improve significantly, the drug treatment can be maintained. If the symptoms do not improve significantly, CT review of the paranasal sinuses should be performed to observe the obstruction of the sinonasal complex and the mucosal thickening in the paranasal sinuses, and timely nasal endoscopic surgery should be performed. If you cannot tolerate the side effects of medication or do not want to take medication for a long time, you can also actively prepare for surgery and operate after 1 week or so of medication. Chronic sinusitis without nasal polyps is similar to chronic sinusitis with nasal polyps and is also differentiated by the severity of the subjective symptoms 1. If there is no significant improvement, add macrolide antibiotics for 3 months and re-examine paranasal sinus CT, if there is still no significant improvement, nasal endoscopic surgery is required. 2.Moderate subjective symptoms: direct nasal glucocorticoid + nasal irrigation + macrolide antibiotics or antibiotics sensitive to bacterial culture for 3 months, review the CT of the paranasal sinuses, if there is no significant improvement, nasal endoscopic surgery is required. 3, the subjective symptoms are heavy, can first short course of oral hormone with nasal glucocorticoids + macrolide antibiotics or bacterial culture sensitive antibiotics treatment for 1 month, if the symptoms improve significantly, can maintain drug treatment. If the symptoms do not improve significantly, CT review of the paranasal sinuses should be performed to observe the obstruction of the sinonasal complex and the thickening of the mucous membrane in the paranasal sinuses, and timely nasal endoscopic surgery should be performed. If you cannot tolerate the side effects of medication or do not want to take medication for a long time, you can also prepare for surgery before surgery and operate after about 1 week of medication. Chronic sinusitis with complications: after the necessary preoperative preparation, surgery is performed as soon as possible. Advantages of nasal endoscopy The nasal endoscope has different models with multiple angles, good optical illumination and TV surveillance to obtain a clear surgical field. The surgery is less invasive, shorter, precise and less painful after surgery. For lesions close to the skull base or orbit, conventional craniotomy or facial incision can be avoided, and the procedure is relatively aesthetic and minimally invasive. The correct choice of “medicine” and “surgery” In summary, “medicine” and “surgery” are the same as “Only a reasonable choice of surgery, together with comprehensive drug treatment, can achieve the best treatment effect. In the process of treatment we should avoid the following two situations: Fear of surgery, resistance to surgery Some people believe that surgery is invasive, as long as the surgery will inevitably cause some harm to the body, hearing the word “surgery” will instinctively produce resistance to emotions. There are two sides to everything, there are advantages and disadvantages, drug treatment can only be effective if it reaches the lesion, for severe “chronic sinusitis” long-term drug treatment is ineffective patients, the nasal mucosa is highly edematous, or accompanied by nasal polyps nasal obstruction, only a reasonable choice of surgical treatment to remove the nasal lesion in a timely manner, for Only a reasonable choice of surgical treatment can remove the nasal lesion in time, provide a route of administration for drug therapy, achieve the best therapeutic effect, and substantially improve the quality of life. Moreover, some medications have significant side effects that not every patient can tolerate. In contrast to the “fear of surgery”, some patients who have been suffering from “chronic sinusitis” for a long time and have not undergone comprehensive medication are eager to have surgery, believing that “surgery The “surgery” can solve all the problems and quickly improve the symptoms. First of all, we must get out of the misconception that “surgery is better than medication to remove the root”, not all patients with chronic sinusitis must be treated surgically, and even in a sense, a significant portion of patients with chronic sinusitis can improve their symptoms through systematic medication. Especially for patients with “chronic sinusitis without nasal polyps”, surgery without medication may be overkill, and even postoperative symptoms such as empty nose and strong irritation in the nasal cavity may occur. Therefore, the choice of surgical treatment should be timely and cautious. Finally, it is emphasized that each person’s body is not exactly the same, and the treatment plan for each patient with chronic sinusitis is not uniform, but emphasizes individualized treatment, so please do not interpret the above mechanically.