Inflammation of one or more sinuses is called sinusitis, and the sinuses involved include: maxillary sinus, sieve sinus, frontal sinus and pterygoid sinus, which is a disease with a high incidence in the population and affects the patient’s quality of life. Sinusitis can be categorized into 2 types: acute and chronic sinusitis. Acute sinusitis is mostly caused by upper respiratory tract infections, and bacterial and viral infections can occur simultaneously. Chronic sinusitis is more common than acute, and often involves multiple sinuses at the same time. Etiology Sinusitis can be divided into acute, chronic sinusitis 2 kinds. Acute sinusitis has a duration of 12 weeks. 1. Acute sinusitis Acute sinusitis is caused by upper respiratory tract infections, bacterial and viral infections can be concurrent. The common bacterial flora are Streptococcus pneumoniae, Streptococcus hemolyticus and Staphylococcus pyogenes, followed by Haemophilus influenzae and Catamorpha, the latter being common in children. Other causative organisms are streptococci, anaerobes and Staphylococcus aureus. Those caused by dental disease tend to be anaerobic infections, and the pus is often malodorous. Fungi and allergies may also be causative factors. Acute sinusitis infection often comes from: sinus source infection, nasal source infection, neighboring tissue source infection, blood source infection, trauma source infection, and systemic factors and toxic factors. 2. Chronic sinusitis (1) is caused by acute sinusitis due to improper treatment of acute sinusitis, or not thoroughly treated so that repeated episodes of prolonged, so that it turned into chronic. This is the primary cause of this disease. (2) Obstructive etiology of nasal obstruction diseases, such as nasal polyps, turbinate hypertrophy, nasal stones, nasal septum deviation, nasal tumors, nasal cavity fillings and other obstacles to the nasal cavity and sinus ventilation and drainage, is an important cause of this disease. (3) The virulence of the causative organisms is strong, and some virulent causative organisms, such as type B hemolytic streptococcus when suffering from scarlet fever, the acute sinusitis caused by it is very easy to turn into chronic. (4) Odontogenic infection due to the roots of the upper molar teeth adjacent to the bottom of the maxillary sinus, if the dental disease is not treated, it is easy to become chronic maxillary sinusitis of odontogenic origin. (5) Trauma and foreign body such as traumatic fracture, foreign body retention or blood clot infection, leading to chronic sinusitis. (6) Sinus anatomical factors due to the special or abnormal anatomical structure of each sinus, not conducive to ventilation and drainage, but also for their own factors can not be ignored. (7) Systemic factors include various chronic diseases, malnutrition, fatigue caused by low body resistance. At the same time, there are all kinds of allergic factors and bronchial dilatation induced by the etiology. Clinical manifestations 1. Acute sinusitis (1) Prevalence of all groups of people are prone to occur, the younger, older and weaker people are more common. (2) Symptoms (1) Systemic symptoms are often aggravated on the affected side during the course of acute rhinitis, followed by chills and fever, malaise, dysphoria, loss of appetite, and so on, and the systemic symptoms of acute odontogenic maxillary sinusitis are more dramatic. In children, the fever is higher, and in severe cases, systemic symptoms such as convulsions, vomiting and diarrhea may occur. (2) Local symptoms ① nasal obstruction due to nasal mucosal congestion and swelling and secretion accumulation, there may be persistent nasal congestion on the affected side. ② pus and snot on the affected side of the nose with more mucopurulent or purulent secretions blowing out, the initial snot may carry a little blood, odontogenic maxillary sinusitis pus and snot with a foul odor. Local pain and headache acute sinusitis in addition to inflammation leading to nasal pain is often accompanied by a more intense headache, which is due to the sinus cavity mucosal swelling and secretion retention compression or secretion emptying negative pressure triggered by the stimulation of trigeminal nerve endings and caused. Acute sinusitis pain has its regularity in time and location. The former group of sinuses is close to the surface of the skull, and its headaches are mostly in the forehead, inner canthus and cheeks, while the latter group of sinuses is deep in the skull, and its headaches are mostly in the top of the head and the back of the occipital area. Acute maxillary sinusitis: often frontal, cheek or upper teeth pain, light in the morning, heavy in the afternoon. Acute frontal sinusitis morning frontal headache, gradually aggravated, reduced in the afternoon, to the evening all disappeared. Sieve sinusitis is characterized by mild headache limited to the medial canthus or root of the nose, which may also radiate to the top of the head. Pterygoid sinusitis manifests as pain deep in the eyeballs, which may radiate to the top of the head, as well as occipital headaches that are mild in the morning and severe in the afternoon. However, in some people, the pain symptoms are atypical and it is not possible to identify the involved sinus solely on the basis of the characteristics of the headache. ④ Decreased sense of smell. 2. Chronic sinusitis (1) All groups of people are susceptible to the disease, and it is more common in the young, the old and the weak. (2) Symptoms 1) local symptoms ① pus nasal mucus or mucopurulent, yellow or yellow-green, the amount of uncertainty, can flow backward to the pharynx, unilateral odor, most often seen in odontogenic maxillary sinusitis or fungal infections. ② nasal congestion varies in severity, mostly due to nasal mucosal congestion and swelling and increased secretion. Nasal congestion and inflammatory response can lead to olfactory impairment. Headache chronic sinusitis usually has no obvious local pain or headache. If there is a headache, it is often manifested as a dull pain or a feeling of heaviness in the head, which is heavy during the day and light at night. The former group of sinusitis mostly manifests swelling or boring pain in the forehead and root of the nose, and the headache of the latter group of sinusitis is in the top of the head and the posterior occipital area. When suffering from odontogenic maxillary sinusitis, it is often accompanied by pain in the upper teeth of the same side. ⑤ Others, due to the inflow of pus into the pharynx and prolonged use of the mouth to whistle, are often accompanied by symptoms of chronic pharyngitis, such as phlegm, foreign body sensation, or dry and painful pharynx. If it affects the eustachian tube, there may be tinnitus, deafness and other symptoms. (2) Other symptoms of eye pressure, can also cause visual impairment, but rare. Heavy pressure in the head, or only a dull or dull pain. (3) Systemic symptoms are mild or inconspicuous, generally there may be dizziness, fatigue, depression, depression, poor appetite, insomnia, memory loss, lack of concentration, reduced work efficiency and other symptoms. Very few cases may have persistent low-grade fever if it has become a lesion. Complications 1. Acute sinusitis The disease affects the patient’s quality of life and may lead to infection of the lower whistling tract and, in severe cases, orbital and intracranial complications. Ocular complications: orbital wall osteitis, periostitis, orbital wall subperiosteal abscess, orbital cellulitis, orbital abscess, retrobulbar optic neuritis. Intracranial complications: epidural abscess, subdural abscess, purulent meningitis, brain abscess, cavernous sinus thrombophlebitis. 2. Chronic sinusitis affects the quality of life of patients, aggravates the symptoms of inhalation tract infection, and may cause cranio-oculopulmonary complications in severe cases, leading to vision changes and even death due to aggravation of infection. Ocular complications: orbital wall osteitis, periostitis, orbital wall subperiosteal abscess, intraorbital cellulitis, intraorbital abscess, retrobulbar optic neuritis. Intracranial complications: epidural abscess, subdural abscess, purulent meningitis, brain abscess, cavernous sinus thrombophlebitis. Treatment 1.Acute sinusitis (1) systemic treatment with adequate amount of antibiotics to control the infection, because most of the coccidioidomycosis, penicillin, cephalosporins as the first choice of drugs, drug therapy emphasizes the selection of sensitive antibiotics, full amount, full course of use. If the headache or local pain is severe, sedatives or analgesics can be used appropriately. General therapy is the same as acute rhinitis. Chinese medicine treatment is based on dispersing wind and clearing heat, aroma and opening the orifices, supplemented by detoxification and removal of blood stasis. (2) Improvement of sinus drainage commonly used drugs containing 1% ephedrine nasal drops, contraction of the nasal cavity, improve drainage. Acute sinusitis can also improve the ventilation and drainage of the sinuses by changing the body position to reduce the headache. (3) maxillary sinus puncture irrigation acute maxillary sinusitis should be in the systemic symptoms subside, local acute inflammation is basically controlled after the implementation. After rinsing, antibacterial solution can be injected, 1 to 2 times a week. (4) Sinus replacement therapy is suitable for children with multiple groups of sinusitis. (5) Etiologic treatment, such as odontogenic maxillary sinusitis should be treated at the same time as dental disease. (6) Mucus promoter therapy can be used to improve the character of secretion and easy to discharge. (7) Hormone therapy can be applied to the nasal local hormone or systemic application of hormones to improve the local inflammatory state and enhance drainage. (8) Surgery acute sinusitis in the drug control is not satisfactory or complications can be used nasal endoscopic surgery, through the endoscopic guide directly to the lesion, open the sinus mouth, remove lesions, improve local drainage, and then restore the normal physiological function of the sinuses. 2. Chronic sinusitis (1) antibiotics Macrolides (macrolide antibiotics) can reduce the toxicity of chronic bacterial infections and reduce cellular damage, although they do not clear bacteria. In cases where hormonal therapy fails, selective application of long-term low-dose macrolide antibiotic therapy is effective. The specific mechanism of action is not very clear, but may be related to the down-regulation of the local host immune response and the weaker virulence of reproducing bacteria (2) Vasoconstrictors can shrink the swollen mucosa of the nasal cavity to facilitate sinus drainage. However, vasoconstrictors should not be used for a long period of time, which may cause secondary drug rhinitis. (3) Mucus promoters add mucus promoters to standard treatments to get better results, mainly by reducing treatment time. (4) AntihistaminesAlthough antihistamines are not recommended in the treatment of chronic rhinosinusitis, a study in the United States showed that antihistamines are still frequently used in the treatment of chronic rhinosinusitis and can significantly reduce sneezing, runny nose and nasal congestion, but do not have a significant effect on the size of nasal polyps. (5) Hypertonic saline Hypertonic saline can improve the cilia clearance rate of nasal mucosa, and the results of some clinical trials show that hypertonic saline has a significant effect in each evaluation index of coughing, runny nose and postnasal drip symptoms. (6) Traditional Chinese medicine is based on the principles of aroma and opening the orifices, clearing heat and removing toxins, and dispelling dampness and draining pus. (7) Physiotherapy generally uses ultra-short-wave diathermy to supplement the treatment. (8) Sinus replacement method is suitable for multiple sinus inflammation and children. (9) Surgical treatment 1) Nasal endoscopic sinus surgery is currently the preferred method. Under the clear vision of nasal endoscopy, the lesions of each sinus are completely removed, and the sinus openings are fully opened to improve sinus drainage and retain normal tissues as much as possible, which is a minimally invasive surgery to retain the function as much as possible. (2) Other surgeries: intranasal opening of maxillary sinus, radical maxillary sinus surgery, intranasal sieve sinus resection, extranasal sieve sinus resection, frontal sinus drilling, frontal sinus incision, pterygoid sinus incision, and so on. For a patient with diagnosed chronic sinusitis, the recommended treatment procedure should be: firstly, medication (including local and systemic application), sinus CT scan if medication is ineffective, and then nasal endoscopic surgery if there are imaging changes and indications for surgery. Prevention 1. Acute sinusitis (1) Strengthen physical exercise, enhance physical fitness, and prevent colds. (2) Acute rhinitis (cold) and dental disease should be actively treated. (3) Don’t blow your nose hard when there is nasal secretion. You should block one nostril to blow out the nasal secretion, and then block the other nostril to blow out the nasal secretion. (4) Promptly and thoroughly treat acute inflammation of the nasal cavity and correct anatomical deformities of the nasal cavity, treat chronic rhinitis and deviated nasal septum. (5) Avoid diving and choking when swimming. (6) It is not advisable to travel by airplane when suffering from acute rhinitis. (7) Proper treatment of allergic diseases, improve the ventilation and drainage of the nasal cavity and sinuses. 2. Chronic sinusitis (1) Strengthen physical exercise, enhance physical fitness, and prevent colds. (2) Acute rhinitis (cold) and dental disease should be actively treated. (3) Don’t blow your nose when there are secretions in the nasal cavity. You should block one nostril to blow out the nasal secretion, and then block the other nostril to blow out the nasal secretion. (4) Promptly and thoroughly treat acute inflammation of the nasal cavity and correct anatomical deformities of the nasal cavity, treat chronic rhinitis and deviated nasal septum. (5) Avoid diving and choking when swimming. (6) It is not advisable to travel by airplane when suffering from acute rhinitis. (7) Proper treatment of allergic diseases and improvement of ventilation and drainage of the nasal cavity and sinuses.