Chronic rhinosinusitis, sinusitis and nasal polyps are common and prevalent in rhinology, with an incidence of about 5% to 15% of the population and an increasing trend year by year. What is chronic sinusitis? The previous concept: it is mostly caused by repeated attacks of acute sinusitis that are not completely cured. The modern view: chronic inflammation of the mucous membrane of the nasal cavity-sinus with a duration of >12 weeks. The symptoms are not completely relieved or even aggravated.
Recognition and transformation of the concept: The study of chronic sinusitis (chronic sinusitis) has been one of the focal issues in otorhinolaryngology, and there are various debates among international and domestic scholars about this disease. In the past, bacterial infection was considered to be the most important cause of chronic sinusitis, while recent studies have recognized that bacterial infection does not play a dominant role in the development of chronic sinusitis, except during acute exacerbations.
In other words: we cannot simply assume that chronic sinusitis develops from acute sinusitis in our understanding. At present, many scholars have gradually over-rhinosinusitis to chronic rhinosinusitis (chronic rhinosinusitis). There is only a word difference between rhinitis, sinusitis and rhinosinusitis, but it contains a huge change in people’s philosophy of diagnosis and treatment of such diseases.
Because it expresses chronic inflammation of the mucosa of the nasal cavity and sinuses, this concept at present more objectively describes the physiopathologic holistic regression of chronic rhinosinusitis, and it provides an important evidence-based basis for understanding the pathogenesis and therapeutic direction of chronic rhinosinusitis. (EPOS2007 and CPOS2008)
Causes and manifestations of chronic rhinosinusitis.
Chronic rhinosinusitis involves a very broad disease entity, which is associated with numerous disease systems such as nasal polyps, allergic rhinitis, asthma, apirin intolerance, cystic fibrosis, etc. Therefore, it is difficult to reveal the connotation of chronic rhinosinusitis with great precision in words. It is associated with the following factors.
1, persistent infection
2, allergic reactions (allergies, nasal polyps)
3, intrinsic factors of the upper respiratory tract, damaged mucosal cilia, anatomical abnormalities (deviated nasal septum, reversed turbinates, hyperplasia, abnormal sieve vesicle development)
4.Bacterial superantigen-induced local immune response
5.Fungal infection (more common in the elderly)
6, metabolic disorders or abnormalities (poor aspirin tolerance).
Clinical manifestations.
1.Main symptoms: nasal congestion, runny nose, mucous, purulent nasal discharge or post-nasal drip.
2.Secondary symptoms: swelling of the head and face, decreased or lost sense of smell.
3.Examination: edema of the mucosa of the middle nasal tract, formation of mucopurulent discharge, with or without nasal polyps, CT: inflammatory changes of the sinus orifice nasal tract complex or sinus mucosa.
Characteristics of chronic rhinosinusitis in the elderly.
1, the elderly because of age and physiological changes, slow metabolism, vascular sclerosis, nasal cilia function activity is reduced, etc., in suffering from chronic rhinitis sinusitis, turbinate edema is sometimes obvious, some can also be transformed into turbinate polyp-like changes, self-defense ability is poorer than the young.
2, due to the elderly nasal mucosa atrophy, glandular secretion function and caused by the performance of nasal congestion, dry nasal cavity, easy bleeding, olfactory hyposmia and other symptoms.
3.Some elderly people are affected by plant nerve dysfunction, and their nasal cavity is dry on the one hand, but they keep running clear water-like nasal discharge on the other hand.
4.The barrier role of mucous membrane in the elderly is weakened, and humoral immunity, cellular immune function and inflammatory stress response are reduced, so rhinosinusitis is more likely to recur.
Prevention and treatment of chronic rhinos – sinusitis in the elderly: many people think that chronic rhinos – sinusitis is easy to recur and difficult to cure, leading to no confidence, haphazard treatment or even give up treatment. Since rhinitis, sinusitis and rhinosinusitis can both affect and transform each other, we cannot and should not separate them diametrically and diagnose and treat them in isolation. Rather, they should be seen as specific manifestations of the same disease in different degrees and sides at different times, stages and conditions, and different treatments should be implemented according to the different conditions in order to achieve satisfactory results.
Prevention.
1, actively prevent respiratory diseases, especially upper respiratory tract infections.
2.Enhance physical fitness and promote immune function. Diet: Fresh fruits and vegetables for vitamin C and bioflavonoids. Citrus fruits (not their juice), grapes and blackberries are particularly beneficial because they also contain bioflavonoids, a substance that, together with vitamin C, keeps the microvasculature healthy and has some anti-inflammatory effects. Also sunflower seeds, seed oil. Nuts, rich in vitamin E, can promote immune function.
3, maintain a good state of mind and lifestyle habits, choose the appropriate physical exercise. Walking, dancing, tai chi, etc.
4, actively treat related diseases: chronic pharyngitis, diabetes, asthma and other allergic diseases.
Treatment.
Elderly people with chronic rhinos – sinusitis, should go to a regular hospital for consultation and treatment, do not believe in prescriptions to avoid delaying treatment or even aggravate the condition. Through the relevant examination to make a correct diagnosis, staging and typing, for different periods of illness and specific circumstances to make the appropriate treatment means. (Specific treatment details are more detailed, this lecture mainly focuses on precautions and principles)
1, grasp the drug indications, not long-term abuse of antibiotics (chronic rhinosinusitis treatment is an anti-inflammatory process, not anti-infective process) and nasal constriction drugs (drug rhinitis). In the chronic phase with acute exacerbations, cephalosporin antibiotics can be used, and in the chronic phase, 14 metacyclic macrolides – macrolide drugs for the treatment of CRS are based on three mechanisms of action: antibacterial, anti-inflammatory and antibacterial biofilm. (Roxithromycin, clarithromycin, etc.).
2. Establish the awareness of long-term standardized treatment, at least 3 months of medication for chronic rhinos – sinusitis, and longer if accompanied by nasal polyps or allergy symptoms. (Note: How to understand the safety of small doses of long-term medication?14 metacyclic macrolides are metabolized through the liver, and very few people who take them will experience an increase in liver transaminases, sometimes unrelated to the dose. This abnormality in liver function is potentially serious, but reversible.
Of course, since long-term oral low-dose macrolide therapy is used, regular liver function checks are necessary. The more frequent adverse effects are gastrointestinal discomfort, such as nausea and diarrhea. Avoidance or prevention of gastrointestinal discomfort can be achieved by drinking more yogurt to replenish the necessary lactic acid bacteria in the intestine. Although problems such as transient intestinal or oropharyngeal bacterial resistance and oral candidiasis can occur after taking the drug, such problems will gradually disappear after stopping the drug.
The process of macrolides in the treatment of respiratory diseases is an anti-inflammatory process, not an anti-infective process, so more than 3 months of treatment is needed).
3. Pay attention to the mutual effects of medication on other common diseases in the elderly, such as the effects of oral hormones on diabetes and peptic ulcer, drug-induced allergy and asthma, etc. In terms of medication for long-term treatment, the elderly must take the right amount of medication because the plasma drug concentration is higher than that of young people after taking medication, and if the medication is still given in the conventional dose, the toxic side effects of the medication may increase and will bring adverse effects to the organism. Therefore, when the elderly are treated with drugs, the right amount of drugs should be given according to their physical condition, age and the presence of heart, liver, kidney and other disorders.
4. Properly understand the role of surgery, reduce the damage to the normal mucosa of the nasal cavity, and do not casually perform invasive nasal operations. (turbinate microwave, excision, turbinate injection, nasal cavity drug application, etc.)
5.Pay attention to the standardized treatment before and after surgery and regular review.