I. What is meant by rhinosinusitis?
Sinusitis is an inflammatory disease of the mucous membrane of the sinuses, mostly coexisting with rhinitis, so it is also called rhinosinusitis, with an incidence of about 15%. It is one of the most common diseases in the rhinology clinic. Sinusitis is classified as single sinusitis, multiple sinusitis, and total sinusitis according to the location where it occurs. According to the occurrence and duration of symptoms and signs are divided into acute sinusitis, subacute sinusitis, chronic sinusitis.
Second, the nose – what is the performance of sinusitis?
Systemic manifestations: acute is heavy, mainly manifested as irritability, chills, fever, headache, depression and drowsiness as in the cold, more common in children. Chronic cases are lighter, mainly manifesting as dizziness, easy tiredness, depression, memory loss, inattention and other phenomena. The impact on students’ learning is more obvious.
Local manifestations: mainly nasal congestion, runny nose, headache, smell disorder, etc.
Why do people suffer from rhinosinusitis?
There are three main reasons.
One is infection: bacteria, viruses, fungal infection of the nasal cavity after the emergence of nasal mucosa edema, resulting in nasal sinus drainage obstruction, nasal secretions increased and the onset;
The second is allergic reaction: which is usually called allergy, also because of nasal mucosa edema and the onset of disease;
Third, the nasal cavity and sinus anatomical abnormalities: such as nasal septum deviation, vesicular middle turbinate or middle turbinate reverse curvature, hooked hypertrophy, etc., on the nasal cavity and sinus ventilation and drainage caused by the impact of the nasal cavity and sinus, resulting in the accumulation of nasal secretions and the onset of disease.
There are also other causes such as: abnormal function of the ciliary system: pharmacological; congenital; long-term placement of a gastric tube; gastroesophageal reflux: mostly occurs in infants and children. Radioactive injury: radioactive treatment of malignant tumors of the head and neck can damage the mucosa of the sinuses, resulting in the accumulation of pus in the sinuses.
Fourth, how to diagnose nasal – sinusitis?
There are three main ways to understand and analyze the medical history, local routine examination and nasal endoscopy, and imaging examination. Among them, CT examination is the most direct and accurate way to diagnose sinusitis and is the gold standard. It can show the location and extent of diseased sinuses, anatomical pathogenic factors, the degree of mucosal lesions in the nasal cavity and sinuses, and can also determine the nature of sinusitis based on certain CT features. However, it is important to choose the right time to do sinus CT: firstly, CT is not done in the acute phase, and secondly, children are best treated before CT is done.
V. How to treat nasal – sinusitis?
The means of treatment is also medication and surgery. However, whether it is surgical or pharmacological treatment, maintaining and improving nasal-sinus morphology and function is the general principle of clinical treatment.
In what cases is pharmacological treatment chosen? If the sinus CT shows only mucosal edema but no anatomical abnormality, medication is the treatment of choice.
What do I need to pay attention to in drug treatment?
Certain drugs that have serious effects on mucosal morphology and function should be prohibited (e.g. naphthazoline hydrochloride – nasal drip), the concentration and continuous use of ephedrine-based decongestants should be limited, and the treatment method of submucosal injection of long-acting hormones or highly corrosive drugs into the turbinates is not recommended.
Antibiotics can be applied in the acute phase, but not in the chronic phase.
Mucus-thinning and mucosal cilia-activating drugs can be applied to promote healing.
Antihistamines, anti-allergy.
Topical medication
VIII. In what cases do I need surgical treatment? What do I need to pay attention to?
Surgery is an option when sinus CT shows anatomical abnormalities. It is necessary to pay attention to several points: 1. It is necessary to take medication before surgery to reduce intraoperative bleeding, ensure clear intraoperative vision, reduce trauma, and improve the efficacy. 2. Otherwise, the minimally invasive effect will not be achieved, and even side injuries will occur.3. In recent years, some local treatment methods such as radiofrequency, microwave, laser, and electrocautery techniques have been proven to be effective in stopping nasal bleeding, but they can cause large mucosal damage while treating, so the use of some inflammatory diseases of the nasal cavity and sinuses should be eliminated. The use of low-temperature plasma submucosal ablation is recommended.4. Maxillary sinus puncture is not used unless it is done to relieve the symptoms of headache during acute sinusitis. It can be said that what can be cured by maxillary sinus puncture can also be cured by medication, and what cannot be cured by medication can certainly not be cured by puncture. Moreover, puncture can have a bad effect on the psychology of children.
(1) Application of decongestants: Acute sinusitis can be used for a short period of time to relieve nasal congestion and sinus mouth obstruction caused by mucosal swelling and improve drainage.
(2) Local glucocorticoids: local glucocorticoids have powerful anti-inflammatory and anti-edema effects, regardless of the etiology of infectious or allergic, the severity of the lesion and its scope, local glucocorticoids can be used as the main medication; the use time is: more than 1 month for acute sinusitis, more than 3 months for chronic sinusitis, and more than 6 to 12 months after surgery for nasal polyps in chronic sinusitis.
(3) saline rinse: nasal rinse (0.9% to 2.8% saline) is not only an important element of treatment, but has gradually become an important way of nasal health care for humans.
In short the treatment of nasal disease has gradually moved away from destructive means and has become more focused on maintaining and improving function.