Chronic rhinosinusitis is a chronic inflammation of the mucous membrane of the nasal cavity and sinuses with nasal symptoms that have not completely resolved or even worsened for more than 12 weeks.
I. Diagnosis
(A) Symptoms
1.Main symptoms: nasal congestion, mucous, purulent nasal discharge; memory loss, inattention, etc.
2.Secondary symptoms: head and face swelling and pain, loss or disappearance of sense of smell.
(II) Examination
1.Nasal cavity examination: from middle nasal tract, olfactory fissure before mucopurulent secretion, middle nasal tract mucosa congestion, edema or nasal polyps.
2.Imaging examination: CT scan shows sinus orifice nasal tract complex or sinus mucosal lesion.
II. Treatment
(A) drug treatment
1.Anti-inflammatory drugs
(1) glucocorticoids: local use of glucocorticoids in the nose, with anti-inflammatory, anti-edema effect, the course of treatment for not less than 12 weeks; systemic use of glucocorticoids: for severe, recurrent nasal polyps, you can take oral prednisone, the recommended dose of 0, 5mg / (kg, d), morning fasting, once a day, the course of 5-10 days up to 14 days. It is necessary to pay attention to the contraindications of systemic glucocorticosteroid use and closely observe the possible adverse reactions in the course of drug administration. Systemic or intranasal injection of glucocorticosteroids is not recommended.
(2) Macrolide (14 yuan ring) drugs: with anti-inflammatory effect, can be taken orally in small doses (half amount) for a long time, the course of treatment is not less than 12 weeks.
2.Antibacterial drugs
Penicillin, cephalosporins, sulfonamides, macrolides fluoroquinolones and other sensitive drugs for acute exacerbation of chronic rhinosinusitis, conventional dose, the course of treatment is not more than 2 weeks. Local antibiotics for nasal-sinus use are not advocated.
3.Decongestants
Nasal congestion can be used for a short period of time in severe cases, the course of treatment should not exceed 1 week.
4.Mucus pro-discharge agent
Can dilute mucus and improve cilia activity.
5.Systemic antihistamines
For patients with symptoms of allergic reactions, second-generation or new antihistamines can be taken orally.
6.Chinese medicine
Some Chinese herbal medicines are effective in improving the symptoms of chronic rhinosinusitis, which should be treated with evidence.
7.Saline
Used for nasal irrigation.
II. Surgical treatment
(A) Indications for surgery
1.Obvious anatomical abnormalities affecting the sinus-oral nasal tract complex or the drainage of each sinus.
2.Nasal polyps affecting the sinonasal complex or the drainage of the sinuses.
3.Improvement of symptoms by drug treatment is not concealed.
4.Persons with cranial and orbital complications.
(II) Type of surgery
1.Nasal surgery: deviated nasal septum, middle turbinate vesicles, polyps, or polyp-like changes, hypertrophic rhinitis, nasal foreign bodies and tumors, etc., are the causes of obstruction in the sinonasal tract complex area and must be surgically corrected or removed.
2.Sinus surgery: The surgical methods can be divided into traditional surgery and nasal endoscopic surgery. At present, nasal endoscopic surgery has taken a mainstream position in rhinology. The key to surgery is to lift the drainage and ventilation obstruction of the nasal cavity and sinus opening, and to preserve as much as possible the basic structures of the nasal cavity and sinuses, such as the middle turbinate, normal mucosa of the sinuses and the diseased mucosa that can be benignly transferred. The aim is to maintain and restore the physiological function of the nasal cavity and sinuses.
Functional Endoscopic Sinus Surgery Functional endoscopic sinus surgery is a new surgical treatment for chronic sinusitis established in the mid-1970s based on the traditional sinus surgery approach. The surgery is aimed at removing the lesions in the nearby area (sinonasal tract complex OMC) centered on the middle nasal tract, especially in the anterior septal sinus, and restoring the drainage and ventilation function of the sinus opening. In other words, the extensive obstructive lesions of the sinuses are relieved by small or limited surgery. For example, hook resection, anterior septal sinus opening, frontal sinus opening, as well as maxillary sinus natural orifice and pterygoid sinus opening enlargement, etc.
FESS has the advantages of clear illumination, all-round vision, fine operation, small trauma, no scar on the face and the ability to completely remove lesions while preserving normal tissues and structures, overcoming the shortcomings of traditional sinus surgery, increasing the clinical cure rate by 80%-90% and greatly reducing the recurrence rate. It has become the main treatment modality for the surgical treatment of chronic sinusitis.