In 2008, the Rhinology Group of the Chinese Medical Association, Branch of Otolaryngology, Head and Neck Surgery, Nanchang, formulated the Guidelines for the Diagnosis and Treatment of Chronic Rhinosinusitis, which defines acute sinusitis and chronic sinusitis as 12 weeks, stating that: chronic rhinosinusitis is a chronic inflammation of the mucous membrane of the nasal cavity and sinuses, with nasal symptoms lasting more than 12 weeks and symptoms not fully relieved or even aggravated during the inter-episode period.
I. To guide clinical research and prognostic assessment of the disease, chronic rhinosinusitis is divided into two main categories.
1. chronic rhinosinusitis (without nasal polyps)
2. chronic rhinosinusitis (with nasal polyps)
Second, how to diagnose sinusitis.
1.According to the patient’s clinical symptoms
(1) Primary symptoms: nasal congestion, mucous, purulent nasal discharge.
(2) Secondary symptoms: head and facial swelling and pain, decreased or lost sense of smell.
2.Diagnosis of sinusitis requires which type of necessary tests.
(1) Nasal examination.
(2)Imaging examination: CT scan
3. Determination of the severity of the disease: The impact of sinusitis on the patient’s quality of life is the basis for determination.
Sinusitis drug treatment: At present, domestic and foreign research agreed: most sinusitis, especially children, adolescents, sinusitis, after systematic standardized drug treatment, can achieve good results.
1.Anti-inflammatory drugs
(1) Glucocorticoids.
A. Intranasal local glucocorticoids: with anti-inflammatory and anti-edema effects, the course of treatment is not less than 12 weeks; emphasize that whether or not accompanied by nasal polyps, whether pure drug treatment or drug + surgical treatment, whether preoperative or postoperative treatment, intranasal local glucocorticoids are the first-line treatment of chronic rhinosinusitis.
B. Systemic glucocorticoids: oral prednisone (or prednisolone) can be given at the recommended dose of 0.5 mg/(Kg.d), once daily in the morning on an empty stomach, for 5-10 days and up to 14 days. It is emphasized that it must be taken under medical supervision and is generally indicated only for severe, recurrent nasal polyps, and that contraindications and side effects of the drug should be noted.
Systemic or intranasal glucocorticoid injections are not recommended.
(2) Macrolide (14-membered ring) drugs (e.g. clarithromycin, roxithromycin).
The main action is anti-inflammatory, not antibacterial.
Recommended small doses (1/2 of the conventional antibacterial dose) long-term (not less than 12 weeks of treatment) oral
The main inflammatory factors and mediators are IL-1, 4, 5, 6, 8, GM-CSF, TNF-a, ECP, etc. No drug has been able to cover these active substances well, so we recommend the use of “dual pathway anti-inflammatory therapy”. Therefore, it is recommended to use “dual pathway anti-inflammatory therapy”, using local glucocorticoids, mainly on eosinophils, and 14-membered cyclic macrolides, mainly on neutrophils, to achieve good anti-inflammatory effects.
2, antibacterial drugs: penicillins, cephalosporins, sulfonamides, macrolides, fluoroquinolones and other sensitive drugs for acute exacerbations of chronic rhinosinusitis, conventional doses, the course of treatment does not exceed 2 weeks.
Topical antibiotics for nasal-sinus use are not recommended.
3. Decongestants (ephedrine, hydroxymetazoline): not recommended for long-term use, only when it seriously affects the patient’s quality of life (for example: acute exacerbation, causing severe nasal congestion, headache.