I. The concept of chronic sinusitis
1.Inflammation: physiological response of tissues to various injuries
2, rhinitis: inflammatory response of the nasal mucosa, the main pathological changes of multiple diseases of the upper respiratory tract, the expression of humoral and cellular immune mechanisms.
3, characteristics: 2 or more signs and symptoms (most patients think it is a cold) Studio Otolaryngology Head and Neck Surgery Xiao Jizian
l Nasal congestion, nasal itching, sneezing, runny nose, decreased sense of smell, headache
l polypoid nasal mucosa, congestion of nasal mucosa, mucopurulent discharge from the nasal passages seen during nasal endoscopy
nasal mucosa hyperplasia and fluid accumulation in the sinuses can be seen in CT examination of the nasal cavity
4.Stage typing of chronic sinusitis.
Type 1 Simplex chronic sinusitis
Stage 1: solitary sinusitis.
Stage 2: multiple sinusitis.
Phase 3: total sinusitis.
Type 2 chronic sinusitis nasal polyps
Stage 1: solitary sinusitis with solitary nasal polyp.
Stage 2: multiple sinusitis with meh-emerging nasal polyps.
Stage 3: total sinusitis with multiple nasal polyps.
Type 3: full sinusitis with multiple, recurrent nasal polyps and or septal sinus osteophytes
Second, the perioperative treatment of nasal polyps in chronic sinusitis
Pre-operative period (pre-operative preparation period): 7-14 days
Mid-operative period (inpatient treatment period): 5-7 days
Post-operative period (post-operative follow-up period): 6-10 months
1.Pre-operative period (pre-operative preparation period: 7-14 days)
l Anti-infection: conventional doses of antibiotics such as: Ao Guang, Zhonglian Rhinitis Tablets (according to our department, patients who need surgery such as those who cannot be hospitalized for five days after surgery can be medicated on an outpatient basis, and CT examinations can be examined after medication which can reduce the effects of acute inflammation)
l Mucosal pro-discharge agents: Genoton, Mucosolvan
l Anti-inflammatory, anti-edema, anti-allergic.
Topical steroids: colecalciferol, ryanodine, endosulfan, etc. (all patients)
Systemic steroids: dexamethasone, prednisone (those with obvious allergic factors present)
Anti-allergic reactions: Enzyme, Petronectin, Keratan
It is of great significance to reduce intraoperative bleeding, intraoperative determination of mucous membrane of the lesion, and to improve the quality of surgery.
2.Mid-surgery (hospitalization period: 5-7 days)
l Comprehensive examination: CT, test, cardiovascular, important organs
l Determine the operation style: according to the CT scan results and the patient’s physical condition
l Determine anesthesia: according to medical history, CT, patient status
l Psychological preparation: explanation of the condition, purpose, modality, results, possible abnormalities and consequences, significance of the need for long-term post-operative follow-up by the opponent
l Signing the consent form for surgery
l Medication during admission: (1) For those who have undergone drug treatment before admission, regular doses of oral antibiotics (cephalosporins, quinolones)
(2) For those who were not treated with medication before admission, antibiotics were given intravenously in regular doses
(3) Dexamethasone 3 tablets, dose or 10mg intravenously
Local medication Topical steroids: colecalciferol, ryanodine, endosulfan, etc.
Local management Negative pressure replacement or maxillary sinus irrigation
Treatment time 2-3 days
(4) Treatment of nasal cavity after surgery
(1) 24 hours to draw out nasal stuffing
2）If there is inferior turbinate surgery, the stuffing will be extracted within 48 hours
3）Treatment of the operative cavity once from the 5th day of extraction of the stuffing: contraction of anesthesia, aspiration of secretions and accumulated blood, saline rinsing of the operative cavity containing gentamicin and dexamethasone
(4) Before discharge, a thorough cleaning and rinsing of the operative cavity under the nasal endoscope
3.Late surgical treatment (postoperative follow-up treatment for about 6-10 months)
l Anti-infective drugs: regular doses of oral antibiotics for about 1 week
l Anti-allergic reaction, anti-inflammatory, anti-edema: Enzyme, Petronectin, Keratan for two weeks
l Local: local steroid hormones, etc., for more than 3 months
l Systemic: dexamethasone or prednisone (severe mucosal edema)
3# 7 days, 2# 7 days, 1# 7 days
l Mucus pro-discharge agents: Genoton, Mucosolvan 3 months
l Topical irrigation : at least 3 months
l Chinese herbal medicine : oral or topical flushes are available Topical steroid hormones are reliable for controlling polyp recurrence