What is chronic sinusitis?
Chronic purulent sinusitis, also known as chronic sinusitis (what people call “sinusitis” in normal life actually does not distinguish between acute sinusitis and chronic sinusitis), is a chronic purulent inflammation of the mucous membrane and submucous tissue of the sinuses, and because it often causes or coexists with the mucous membrane of the nasal cavity and its submucous lesions, it is also called chronic rhinosinusitis. -sinusitis. The disease is characterized by nasal congestion, abscesses, impaired sense of smell, or headache. Chronic maxillary sinusitis and chronic septal sinusitis are the most common clinical conditions.
What are the causes of chronic sinusitis?
The causes of chronic sinusitis are mainly divided into the following categories, and often multiple factors coexist.
I. Infection factors
Microbial infection is the direct cause of chronic sinusitis. The causative organisms are mainly septic cocci, but also bacilli and anaerobes, as well as fungal infections, mostly mixed infections. The main sources of infection are.
1, acute sinusitis is not completely cured, the course of the disease is prolonged, which is the most important.
2, the influence of adjacent organ lesions: such as chronic tonsillitis, pediatric adenoiditis, can lead to long-term obstruction of the nasal cavity, causing sinusitis; as the maxillary sinus and long in the long jaw adjacent to the teeth, if there are worm teeth (dental caries), causing tooth root infection, may cause acute or chronic inflammation of maxillary sinusitis.
3, other reasons: swimming water into the nasal cavity, into the sinuses, bacteria followed by entry, can cause sinusitis; when flying, during the take-off or descent of the aircraft, for patients with pre-existing nasal disease, due to changes in air pressure, bacteria may enter the sinuses, causing sinusitis, and so on.
Second, the nasal cavity and sinus drainage is not good
1, nasal polyps, excessive deviation of the nasal septum, so that the nasal cavity is not smooth, the sinus opening is obstructed, causing inflammation in the sinuses.
2, allergic rhinitis, chronic rhinitis and other lesions, the nasal mucosa long-term chronic congestion, sinus openings are obstructed, can further cause chronic sinusitis.
3, the long-term presence of foreign bodies in the nasal cavity, or nasal surgery after the blockage of a long time, blocking the opening of the sinuses, resulting in sinusitis.
Three, the immune function is insufficient
1, local immune dysfunction of the nasal mucosa: due to environmental pollution, improper nasal medication (long-term use of certain nasal drops, blowing medicine into the nose, long-term nasal wash, etc.), improper treatment (turbinate microwave, laser, partial excision, regular chemical cautery, etc.), resulting in the nasal cavity and sinus mucosal epithelium cilia function (its function is to spit out toxic and harmful substances backward discharge), local immune function is insufficient (nasal mucosa The mucus secreted has abundant immunologically active substances, such as a variety of immunoglobulins, lysozyme, interferon, etc.), etc., which may be one of the factors of chronic sinusitis.
2, poor health, low immune function, allergic constitution, easy to feel the upper whistle infection, causing bacterial infection or fungal infection in the sinuses for a long time, and with allergic reactive, thus forming chronic sinusitis.
3, systemic chronic diseases, as well as excessive addiction to tobacco and alcohol, resulting in low immune function of the body, prone to chronic sinusitis.
4, bronchiectasis, of which congenital bronchiectasis and chronic sinusitis occur at the same time, may be related to chromosomal genetic disease; acquired bronchiectasis is also often present at the same time with chronic sinusitis, the mechanism is unknown.
What complications can be caused by chronic sinusitis?
Chronic sinusitis in adults can cause the following complications: sinus cysts, sinus polyps, nasal polyps, atrophic rhinitis, olfactory disorders, otitis media, nasopharyngitis, pharyngitis, laryngitis, etc.; sinusitis can cause dizziness and brain swelling, or headache, memory loss, loss of appetite; in severe cases, it may also cause optic neuritis (visual impairment), orbital bone infection, intracranial infection, etc.; clinically, some Sinus malignancies are closely related to long-term chronic sinusitis. In general, chronic sinusitis in children is more dangerous.
What are the key points in the diagnosis of chronic sinusitis?
Chronic sinusitis is generally easier to diagnose. If the symptoms are typical, the outpatient doctor can see purulent secretions in the nasal passages, and then combined with the patient’s symptoms and medical history, the diagnosis can be generally confirmed; if the symptoms are not typical, or clearly what sinus inflammation, it is necessary to conduct an X-ray or CT examination, and most of them are currently using CT examination.
1.History: Most of them have a history of cold and cause runny nose, and the duration of the disease is long.
2.Main symptoms.
(1) Purulent snot: yellow or green snot, or white snot, the heavier the lesion, the more snot volume.
(2) Nasal congestion: the heavier the lesion, the heavier or more obvious the nasal congestion on the side of the lesion.
3.Other symptoms.
(1) Due to nasal congestion, the toxins in inflammatory secretions are absorbed, which can cause headache and dizziness.
(2) Due to nasal congestion, it can cause smell disorder.
(3) It may be accompanied by various symptoms of the above-mentioned complications.
4. Nasal examination: swollen turbinates and purulent secretions in the nasal passages. Or accompanied by turbinate polypoid changes, nasal polyps; if it causes secondary atrophic rhinitis, the turbinates become smaller.
5.X-ray or CT examination: is an important basis for the diagnosis of sinusitis. It can be seen that the mucous membrane in the diseased sinus is thickened and blurred, or there are shadows of soft tissue in the sinus (mostly polyps in the sinus) or shadows of pus accumulation; it can be seen whether the opening of the sinus is open.
How does Western medicine treat chronic sinusitis?
The main objectives of Western medicine in the treatment of chronic sinusitis are to keep the nasal and sinus drains open, to eliminate inflammation, and to prevent complications. According to these three objectives, various methods are therefore used flexibly and in conjunction with each other. There are three main categories of these methods, namely conservative therapy, adjuvant surgical therapy, and surgical therapy.
I. Conservative therapy
1. Nasal drops: There are generally two types of drugs, namely decongestants and anti-inflammatory agents.
(1) decongestant nasal drops: the main purpose is to make the nasal mucosa contraction, in order to reduce congestion and swelling of the nasal mucosa, contraction of the mucosa at the opening of the sinuses, so as to help keep the drainage of the nasal cavity and sinuses smooth, reduce nasal congestion and various symptoms caused by nasal congestion. Commonly used decongestants are: 1% ephedrine nasal drops, selorazoline nasal spray (Norton), hydroxymetazoline hydrochloride nasal drops (Dafenlin), naphthazoline hydrochloride nasal drops, etc.. But at present, this method is less used.
Among them, it is worth emphasizing in particular.
For decongestants, long-term use is not advisable, and the method of using three days and stopping three days can be considered to extend the use schedule and reduce the risk of possible complications of drug rhinitis due to long-term nasal drops of decongestants.
However, some people now hear that decongestants may cause drug rhinitis, so they simply do not use it, which is also incorrect, or is a misunderstanding. The role of decongestants is mainly to contract the nasal mucosa, by contracting the nasal mucosa, that is, to open the nasal passages, especially the opening of the sinuses, thus facilitating the discharge of secretions from the sinuses, alleviating the symptoms of nasal congestion, alleviating a series of symptoms (such as headache and dizziness) caused by the retention of secretions in the sinuses, and promoting improvement or faster improvement. Therefore, the use of decongestants is also extremely necessary.
(2) Anti-inflammatory agent nasal drops: The main purpose is to eliminate chronic inflammation of the nasal cavity and sinuses, thus promoting the improvement of sinusitis. Commonly used drugs are antibiotic nasal drops, astringent preparations, such as nasal inflammation net (nano-silver antibacterial hydrogel), 10% weak protein silver, hormonal preparations, such as tretinoin nasal spray (used when accompanied by allergic lesions), antihistamine preparations, such as nostatin nasal spray (used when accompanied by allergic lesions), and herbal preparations.
2. Oral anti-inflammatory drugs.
(1) antibiotics: because of chronic sinusitis, although there is a bacterial infection, but the bacterial infection does not dominate, and chronic inflammation when the bacteria are not sensitive to anti-inflammatory drugs, therefore, less use of anti-inflammatory drug therapy. However, in recent years, some people advocate that small doses of antibiotics can be used for long-term application, and there are many clinical reports of better results, but changes in liver function should be closely monitored to avoid liver damage or other complications. Clinically, the commonly used anti-inflammatory drugs for the treatment of chronic sinusitis are mainly: erythromycin, roxithromycin, clarithromycin and azithromycin, all four of which belong to the macrolide antibiotics and can be applied simultaneously with Chinese medicine.
(2) Promote mucosal epithelial cilia clearance and excretion function preparations (pro-discharge agents): commonly used drugs are standard myrtle oil enteric capsules (Genotone), eucalyptus citrus pinin enteric soft capsules (Chenault). These drugs also have direct bactericidal and antibacterial effects. It can be used alone or as an adjunct to antibiotics.
(3) Immune function modulators: New drugs commonly used at present include Vancianin (pidomod tablets). It can be used for recurrent sinusitis in patients with suppressed cellular immune function to reduce the number of acute attacks, shorten the duration of the disease and reduce the degree of attacks. Generally, it needs to be used continuously for 60 days.
(4) Mycobacterial preparation: Used for mycosis (fungal) sinusitis.
3.Replacement therapy: Especially suitable for children with whole group sinusitis. The method is to put a large number of drops of the drug solution (1% ephedrine, gentamicin, saline, etc.) into the nasal cavity, and then repeatedly suction with negative pressure attraction, due to the effect of negative pressure, the purulent secretions in the nasal cavity will be sucked out, and the drug solution into the sinuses, thus playing a role in cleaning the sinuses with the drug acting directly on the lesion local. Once a day, after several times in a row, it can reduce pus, improve nasal congestion and various symptoms caused by nasal congestion.
4.Maxillary sinus puncture rinse: suitable for chronic maxillary sinusitis. The purulent secretions in the maxillary sinus are flushed out, and anti-inflammatory drugs are injected into the maxillary sinus and retained, which has a better effect.
Second, surgical treatment
Generally chronic sinusitis after conservative treatment is ineffective can choose surgical treatment for the obstructive degenerative disease leading to poor drainage of the nasal cavity and sinusitis using surgical methods to facilitate the smooth drainage of the nasal cavity and sinuses, thus playing a role in helping other therapies for sinusitis to achieve therapeutic results. The main methods are.
1, nasal septum correction: for patients with significant nasal septal deviation.
2, nasal polyp removal: for patients with nasal polyps.
3.Nasal endoscopic sinus opening.
4.Other: If there is a polyp-like change of the turbinate, the necessary surgical treatment of the diseased turbinate can be performed, such as microwave, laser, plasma surgery. Thus, it is beneficial to improve the drainage of the nasal cavity and sinuses.
The range of indications for surgery for chronic sinusitis.
The main indications that require surgical treatment are.
(1) When the deviation of the nasal septum is obvious and needs to be corrected, corrective surgery of the septum should be performed and functional endoscopic surgery of the sinuses can be considered at the same time.
(2) nasal polyps that obstruct the drainage of the nasal cavity and sinuses, nasal polyp removal surgery should be performed, and functional endoscopic surgery of the sinuses can be considered at the same time.
(3) Sinuses with polyps or large cysts, which are not conducive to the early resolution of inflammation, should be surgically removed from the sinus lesions.
(4) on CT films, abnormal sinus anatomy, obstructed drainage of the sinuses, long duration of the disease, obvious symptoms, and poor results of conservative treatment, should be treated surgically
(5) chronic sinusitis with soft tissue density shadowing of the mucosa in the sinus cavity (possibly mucosal hypertrophy, sinus polyps), surgery may be considered.
(6) Chronic sinusitis, where the patient strongly requests surgical treatment, with the possibility of faster results, can be considered. However, in children and minors, surgical treatment is generally contraindicated or functional endoscopic surgery may be considered.
The effectiveness of surgical therapy varies from person to person (determined by each individual’s physique and condition, as well as by the quality of the procedure). It should be said that in most cases, the results of surgery are good, especially if the patient is in good health and the quality of surgery is good. However, it is not uncommon for some patients to have poor health, to catch a cold easily, to have a complicated sinusitis, or to have a poor quality surgery, resulting in less than ideal results. In recent years, the technology of surgery for chronic sinusitis has been improving, making it easier to perform surgery for chronic sinusitis (functional endoscopic surgery), coupled with the fact that conservative treatment for chronic sinusitis in Western medicine is not very effective, so the use of surgery for chronic sinusitis in Western medicine is becoming more and more common. However, it is worth noting that surgery can solve some problems or major problems, but it cannot solve all the problems of chronic inflammation of chronic sinusitis, especially those patients with poor health (weak resistance), and they cannot expect to be cured after 1 surgery. These patients may feel satisfied with the significant improvement of symptoms in the first few months after surgery, but after a few months, nasal congestion, runny nose, or headache will gradually reappear. Therefore, it is best to continue systematic treatment with Chinese medicine for a period of time (about 2 months) after the Western medical surgery in order to consolidate the efficacy and make recurrence difficult. As long as there is no cold for about six months to a year, or the occasional cold can be treated quickly to control the inflammation without prolongation, chronic sinusitis will not be easy to recur. Therefore, if you do not have the indications for surgery, and if you can use conservative therapy (especially conservative therapy based on Chinese medicine) to get results, you do not need surgery.
How to treat chronic sinusitis with nasal polyp, deviated septum, turbinate polypoid, sinus cyst, sinus polyp?
The chronic sinusitis with nasal polyps, turbinate polyp-like changes, mostly due to the long-term chronic sinusitis; or with the deviation of the septum, these conditions have become obstacles to the drainage of the nasal cavity and sinuses, is not conducive to the treatment of sinusitis, but also can aggravate or cause sinusitis, for such conditions, the use of Chinese medicine is ineffective or ineffective, it is best to use complementary surgical methods, first solve these problems, and then take Chinese medicine, the effect It is better.
If there are sinus polyps, surgery is generally advisable for the treatment of polyps. If there is a sinus cyst, surgery is also recommended as an option.
How to prevent the recurrence of chronic sinusitis?
The recurrence of chronic sinusitis is mainly caused by colds, so preventing colds is the best way to prevent the recurrence of chronic sinusitis. The main methods to prevent colds are.
(1) actively calcine the body, enhance physical fitness and strengthen the ability to resist diseases.
(2) Wash your face with cold water every day (perennial) to enhance the cold resistance of the nose (not suitable during menstruation, especially on cold days); people who are prone to colds can regularly rub the back of the nose up and down with their fingers for 1-2 minutes on both sides, several times a day.
(3) Add and remove clothes at the right time. To avoid getting cold and heat too much.
(4) conscious of a cold, quickly take the treatment of cold drugs to control (drug selection according to the patient’s own experience can be), can make it free of hair; otherwise, the natural course of the cold for a few days, it can cause an acute relapse of chronic sinusitis.
(5) Women are prone to colds during menstruation and should pay special attention.
Can chronic sinusitis be completely cured?
1, through medical treatment, the symptoms of chronic sinusitis can disappear completely, but it cannot be called a cure. The reason is that the medical cure must be completely normal in all kinds of examination in order to be called a cure. And chronic sinusitis, even if there are no symptoms, there may be positive (lesion) signs during the examination, especially when X-ray or CT examination can be found. However, these positive signs can also disappear completely with time, as long as there are no more relapses. In this case, it is self-healing, not a cure.
2, clinically, doctors treat chronic sinusitis, or patients receive treatment, as long as there is a considerable period of time about the symptoms basically disappeared (no obvious nasal congestion, or only occasionally nasal congestion; such as no mucous snot blowing out; no headache), but also can suspend treatment, as long as all aspects of the body is better, pay attention to the prevention of colds, the future does not (at least six months) again recurrence of colds caused by chronic sinusitis recurrence, a long time Chronic sinusitis can also be basically self-healing. In this case, it is not a cure, but a self-healing. In fact, the body’s resistance is strong, and although medical treatment does not completely eliminate the positive signs of chronic sinusitis (among them, especially the positive signs during sinus examination by X-ray or CT, mainly mucosal thickening), the body’s self-repair over a longer period of time will be completely back to normal.
Therefore, in most cases, chronic sinusitis is not “cured”, but “self-healing”, relying on the body’s own repair. However, this does not mean that medical treatment is not needed. Medical treatment is very necessary, and the body’s own repair is also very important.
In fact, there are many chronic diseases in a similar situation, such as chronic bronchitis, asthma, chronic pharyngitis, allergic rhinitis, etc., also rely on “self-healing”, not exactly medical “cure”.