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Abstract: Chronic sinusitis can be divided into two types: chronic sinusitis without nasal polyps, and chronic sinusitis with nasal polyps, with complex pathogenesis, mainly manifesting as nasal non-ventilation, mucous pus nasal discharge, decreased sense of smell, and a feeling of head swelling and pain. In this case, the patient came to the clinic with nasal congestion with headache for one year and said that it was relieved after taking cold medication, and then recurred after stopping the medication, so the patient was suggested to improve sinus CT, and after the examination results were confirmed as chronic sinusitis, and the symptoms improved after surgical treatment.
Basic information】Male, 52 years old
Disease Type】Chronic sinusitis
Hospital】Northern War Zone General Hospital
Date of consultation】May 2021
Treatment plan] Preoperative preparation (nasal washers to rinse the nasal cavity + budesonide nasal spray) + surgical treatment (nasal endoscopic surgery of the right maxillary sinus and bilateral septal sinus openings under general anesthesia + tumescent sponge filling) + postoperative medication (anti-inflammatory cefuroxime sodium for injection + ornidazole injection + eucalyptus lemongrass enteric soft capsule) + saline nasal washings
[Treatment period] 1 month of inpatient treatment
Treatment effect】Postoperative nasal congestion and headache disappeared
I. Initial consultation
After the interview, we exchanged detailed medical history with the patient. The patient reported that he had nasal congestion and headache after catching a cold one year ago. Because of the headache, he often felt that his memory was reduced, he did not sleep well, which affected his normal work and life, and he was always depressed, so he came to the clinic. Subsequently, the patient was advised to improve the coronal CT of the sinuses, which suggested bilateral pterygoid sinuses, mucosal thickening of the right maxillary sinus and bilateral septal sinuses, turbid hyperdense shadows in the sinus cavity, with the right maxillary sinus and bilateral septal sinuses predominating, obvious obstruction of the maxillary sinus opening, no abnormalities in the bone structure of each sinus, the nasal septum roughly in the middle, and slightly hypertrophied bilateral inferior turbinates. According to the patient’s symptoms and examination results, the current diagnosis is chronic sinusitis, and according to the According to the CT film examination results, the patient was recommended to be hospitalized for surgery, and the patient agreed to go through the hospitalization procedure after communicating with his family.
II. Treatment process
Because of the patient’s sinus and nasal mucosa congestion and chronic inflammation, in order to prepare for surgery, the patient was advised to go home first for local preparation of the nasal cavity, applying nasal washers to rinse the nasal cavity for 1 week, and applying budesonide nasal spray to reduce nasal inflammation bilaterally, which can reduce intraoperative congestion and prevent postoperative infection, and to go through the admission procedure after 1 week, and after admission, he actively improved the preoperative related examinations, including chest X-ray, electrocardiogram, and blood-related routine examination. After admission, the patient had no absolute contraindications to surgery, and was scheduled to undergo nasal endoscopic surgery under general anesthesia for the right maxillary sinus and bilateral septal sinus openings, and the turbinate hypertrophy was not obvious and was not treated intraoperatively. The patient was given cefuroxime sodium for injection to fight against inflammation, ornidazole injection to fight against anaerobic bacterial infection, and eucalyptus pinene enteric soft capsule for oral administration to promote the outward drainage of secretions from the sinus cavity.
III. Treatment effect
On the next day of surgery, the patient reported headache, and explained to the patient that the swelling sponge was considered to be the cause of stuffing, and the swelling sponge could be removed on the 2nd postoperative day. The patient reported that the nasal cavity was well ventilated, the secretions in the nasal cavity were significantly reduced, no headache, no active bleeding in the nasal cavity as suggested by the anterior rhinoscope, a small amount of blood crust was attached, and the patient was discharged after cleaning, the patient was very satisfied with the treatment effect, the whole treatment cycle was about 1 month, the patient’s symptoms improved and the nasal congestion and headache disappeared.
IV. Notes
We are glad that the patient’s nasal congestion and headache disappeared after the treatment. Patients are advised to avoid blowing their noses hard after discharge to prevent active bleeding in the nasal cavity. Since there will be dry crust formation in the nasal cavity, it is necessary to continue to apply saline to cleanse, continue to spray budesonide nasal spray, and take eucalyptus pinene enteric soft capsule orally. If nasal bleeding or nasal congestion is obvious after discharge, go to the hospital to follow up at any time. 1 week after discharge, you need to return to the hospital to review the nasal endoscope to clarify the recovery of the nasal cavity, clean up the nasal secretions to prevent the formation of abdominal adhesions, and ensure a positive state of mind, which is conducive to the recovery of the disease.
V. Personal insight
The majority of chronic sinusitis is caused by acute inflammation that does not heal, so in life with acute sinusitis, must be treated in a timely manner, usually need to exercise properly to improve resistance and reduce the occurrence of colds, chronic sinusitis surgery is very effective, so it is recommended that conservative treatment of ineffective chronic sinusitis patients, actively improve the quality of life through surgery, usually the entire cycle of surgical treatment It is recommended that patients need to review their nasal cavity in time after surgery to help them recover and reduce the chances of sinusitis recurrence.