I. Surgical problems of chronic sinusitis in children
From the point of view of Western medicine, the current treatment of chronic sinusitis in children is generally based on conservative therapy, and surgery is chosen with caution, the younger the age, the more caution is needed.
1. Indications for surgery for chronic sinusitis in children
Surgical treatment can be considered in the following cases, but needs to be chosen carefully.
(1) When chronic sinusitis in children is accompanied by adenoid hypertrophy, which will lead to difficult to cure sinusitis, surgery to remove the adenoids (instead of surgery on the sinuses) can be considered at this time.
(2) If there are obvious or large nasal polyps that affect nasal ventilation and drainage, then sinusitis is difficult to be cured. Consider excision of intranasal polyps without surgical treatment of the tissue structure of the nasal cavity and sinuses as much as possible; for small polyps in the middle nasal tract that do not affect nasal respiratory ventilation, surgical treatment is generally not advocated.
(3) After a phase of systematic conservative therapy (generally not less than 3 months, or longer), chronic sinusitis that is difficult to cure for a long time can be considered for functional endoscopic surgical treatment to clean up the diseased tissue of the nasal cavity or sinuses, which needs to be chosen more carefully than the first two types of surgery.
2.Why you need to choose surgery carefully for children with sinusitis
(1) Children are in the process of development and should not be operated on the sinuses at will (especially traditional surgery). Foreign animal studies have shown that nasal surgery has a significant impact on the development of the jaw and face of piglets, so the surgery may have a greater negative impact on the development of children’s sinuses, teeth, facial bones (children’s unemerged dental embryos have some located at the bottom of the maxillary sinus; maxillary sinus is located in the maxilla; maxilla supports the face, and facial appearance), and the surgery itself also has the potential to cause certain complications is difficult to exclude. In case of nasal adhesions, reoperation is required. In 32 patients (59 sides), 7 of whom had a history of adjuvant surgery (i.e., adenoidectomy or nasal polyp removal), nasal adhesions were reported in 9 cases (13 sides), or 22%, after surgery (Journal of Jinan University, Vol. 6, 2010, P611-613). When sinusitis in children is combined with deviated nasal septum, whether to operate or not needs to be treated with extreme caution.
(2) Children’s immune system is developing, and the immune function is not yet strong; and metaplasia is an important factor in children’s chronic sinusitis, but the enhancement of immune function is not something that can be solved by surgery. Although surgery helps the temporary remission of inflammation, it cannot solve the fundamental problem of the continued existence and recurrence of chronic inflammation of sinusitis, so chronic sinusitis in such children can easily recur after surgery, so that surgery is futile.
(3) Clinically, otorhinolaryngologists in large hospitals generally do not readily advocate surgical treatment of sinusitis in children (especially for the nasal structures and sinuses themselves).
(4) Although it is not uncommon to find reports in the literature on the use of endoscopic surgery for sinusitis in children in the domestic medical community, it is difficult to find reports on the evaluation of long-term (meaning more than one year after surgery) outcomes after surgery. I searched one of the largest Chinese journal resources in China (Wipu Journal Resource Integration Platform) for information on “pediatric sinusitis” from 1989 to 2015, and found only two reports related to the long-term outcome follow-up after surgery. In one of these reports (Pentacameral Care, Vol. 12, 2006, P1131-1133), observations were made for 12-24 months, with a mean of 13 months; of the 115 pediatric cases reported, 20 patients had a history of 1-3 surgeries for sinusitis, which reflects the problem.
II. Surgical problems of enlarged tonsils and adenoids in children
The tonsils and adenoids are the immune organs of the body, especially for children, and are an important guarantee of local immunity. If the tonsils and adenoids are easily removed, clinical studies by more authoritative western medical experts in China have shown that removal of tonsillitis or adenoids before the age of 6 may lead to serious lower respiratory tract infections. Therefore, the choice of surgical removal of tonsils and adenoids in children needs to be made carefully, so that they are preserved as much as possible. The indications for tonsil and adenoidectomy in children are.
(1) If inflammation of tonsils causes heart disease (endomyocarditis), rheumatic fever (arthritis), edema (nephropathy), chronic hypothermia, pharyngeal abscess and other complications, it is appropriate to consider removal of tonsils, so called “the lesser of two evils”.
(2) adenoid hypertrophy caused by secretory otitis media, adenoid hypertrophy accompanied by chronic sinusitis, from the point of view of Western medicine is often considered to remove adenoid hypertrophy, although this view is correct, but personally I think it is “helpless”, because in addition to surgical removal, Western medicine for the elimination of tonsillar hypertrophy, adenoid hypertrophy and no From the point of view of Chinese medicine, through a method based on evidence-based treatment, it is possible to significantly reduce the size of the enlarged tonsils and adenoids, eliminate snoring, reduce recurrence, and remove obstruction to the eustachian tube, or at least postpone the age of surgery (from before 6 years old to after 6 years old, when the immune function is better developed).
III. Surgical problems in children with secretory otitis media
In Western medicine, the main methods of treatment for secretory otitis media are internal anti-inflammatory drugs (antibacterial agents, short courses of hormones if necessary, and mucosal promoters), nasal drops, and etiological treatment according to the cause of otitis media. In the etiologic treatment approach, if there is concomitant adenoid hypertrophy and chronic sinusitis, surgical treatment options are often proposed for the patient’s family to choose from. Therefore, the surgical treatment of secretory otitis media mainly refers to.
(1) If accompanied by adenoid hypertrophy, it needs to be removed in order to release the obstruction to the eustachian tube and facilitate the early cure of secretory otitis media.
(2) If accompanied by chronic sinusitis, functional endoscopic surgery for sinusitis is to eliminate and reduce the inflammation of sinusitis (because the secretion of sinusitis always flows backward to the nasopharynx causing secretory otitis media), thus facilitating the treatment of otitis media.
(3) Tympanotomy and tube placement (also performed under general anesthesia), the main function of which is to eliminate the accumulation of fluid in the tympanic chamber, thus facilitating the early improvement of secretory otitis media. Usually the tubes are placed for six months to a year, and then removed after the otitis media has healed, and the tympanic incision can usually heal on its own. After the operation, attention should be paid to protecting the ear and not entering the sewage so as not to induce purulent otitis media.
Fourth, it is wrong for Western doctors to suggest surgery at every turn and for Chinese doctors to always disregard surgery
Clinically, for the above-mentioned common diseases such as chronic sinusitis, tonsillar hypertrophy, adenoid hypertrophy, and secretory otitis media in children, different doctors may often propose completely different treatment plans (surgery-based or conservative therapy-based), and in the words of the “common people”, “Western doctors In the words of the “common people”, “Western doctors always say that surgery is the main treatment, and Chinese doctors always say that conservative treatment is the main treatment”, this situation, in fact, there may be incorrect aspects, should be specific, specific analysis, careful and correct choice.
1, Western doctors recommend surgery, mainly for two types of reasons.
One, medical considerations: because the effect of conservative therapy based on drugs in Western medicine in many cases is difficult to work, or easy to cause side effects, the natural thought of surgery, although some people think that Chinese medicine is good, but they do not apply, and even a few Western doctors do not care about Chinese medicine;
Second, interest considerations: because surgery can obtain more economic benefits.
2. Some TCM doctors do not value surgery, mainly for two types of reasons.
First, medical considerations: because the above-mentioned diseases, in most cases, can be achieved due to conservative treatment, belonging to the clinical advantages of Chinese medicine, if the effect is not good in the short term, to a certain extent, can be further improved through the identification and treatment of thinking and medication methods to achieve results;
Second, other considerations: including knowledge limitation factors (can not correctly understand the need for surgery), and interest relations (pushing patients to surgery, sometimes equal to reduce the unit or their own interests).
3. How do patients feel about whether Chinese or Western medicine is conservative or surgical advice? This is a question that requires careful consideration by the patient himself. Key points for consideration.
One is to have a clear understanding of the need for surgery (which can be obtained through different means of consultation and listening to the views of different doctors);
The second is a correct assessment of surgical tolerance (surgical risk tolerance, physical condition tolerance, financial condition tolerance), as well as a correct assessment of the tolerance of conservative and surgical treatments, each of which may fail under different circumstances.