During the drafting of the guidelines for the diagnosis and treatment of chronic rhinosinusitis in China, reference was made to the existing international guidelines, and based on the characteristics of China’s national conditions, the principle of “simplicity is preferable to complexity and coarseness is preferable to detail” was followed, while taking into account the current medical system and the actual situation of clinical operability in China. In order to make this guideline more scientific, reasonable and practical, experts have been organized to give lectures in some cities in China and fully solicit opinions from colleagues all over the country, so as to make it perfect. This guideline is applicable to chronic rhinosinusitis in adults.
Clinical definition
Chronic rhinosinusitis is defined as chronic inflammation of the mucous membrane of the nasal cavity and sinuses, with nasal symptoms persisting for more than 12 weeks, without complete resolution or even worsening of symptoms.
Clinical classification
1. chronic rhinosinusitis (without nasal polyps).
2, chronic rhinosinusitis (with nasal polyps).
Note: The mechanism of nasal polyp occurrence is still unclear, and studies have shown that nasal polyps have their own relatively independent characteristics. Therefore, the classification in this guideline does not imply a necessary causal relationship between chronic rhinosinusitis and nasal polyps in terms of stage of development.
Diagnosis
I. Symptoms
1. primary symptoms: nasal congestion, mucous, purulent nasal discharge.
2.Secondary symptoms: head and face swelling and pain, reduced or lost sense of smell.
The diagnosis is based on the above two or more related symptoms, among which nasal congestion, mucous and purulent nasal discharge must be one of the main symptoms.
Examination
1. Nasal examination: mucopurulent secretions from the middle nasal tract and olfactory fissure, congestion and edema of the mucosa of the middle nasal tract or the presence of nasal polyps.
2. Imaging examination: CT scan shows sinus-oral nasal tract complex or nasal tract mucosal lesions.
III. Determination of disease severity
According to the visualanaloguescale (VAS), the condition is classified as mild 0~3, moderate 3~7 and severe 7~10.
Drug treatment
The following categories of drugs are commonly used clinically.
I. Anti-inflammatory drugs
1. Glucocorticoids.
(1) Internal local glucocorticoids: with anti-inflammatory and anti-edema effects, the course of treatment is not less than 12 weeks.
(2) systemic glucocorticoids: for severe, recurrent nasal polyps, oral prednisone (or prednisolone) can be taken at a recommended dose of 0.5 mg/(kg/d), once daily in the morning on an empty stomach, for a course of 5-10 d, up to 14 d. It is necessary to pay attention to the contraindications to the systemic use of glucocorticoids, and closely observe the possible adverse reactions during the use of drugs. Systemic or intranasal injection of glucocorticosteroids is not recommended.
2, macrolide (14 yuan ring) drugs: with anti-inflammatory effect, recommended small dose (1/2 of the conventional antibacterial dose) for long-term oral administration, the course of treatment is not less than 12 weeks.
Second, antibacterial drugs
Penicillins, cephalosporins, sulfonamides, macrolides, fluoroquinolones sensitive drugs for acute exacerbation of chronic rhinosinusitis, conventional dose, the course of treatment not more than 2 weeks. Topical antibiotics for nasal-sinus use are not recommended.
III. Decongestants
Not recommended. Short-term use (<7d) for severe nasal congestion.
IV. Mucus pro-discharge agents
Can thin mucus and improve cilia activity, recommended.
V. Systemic antihistamines
For patients with symptoms of allergic reactions, second-generation or new antihistamines can be administered orally.
Sixth, Chinese medicine
Some herbal medicines are effective in improving the symptoms of chronic rhinosinusitis and should be selected according to the principle of dialectical treatment.
vii. saline or hypertonic saline nasal irrigation, postoperative treatment.
Surgical treatment
I. Indications for surgery
Chronic rhinosinusitis can be treated surgically if one of the following conditions exists.
1. significant 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 each sinus.
3. unsatisfactory improvement of symptoms with pharmacological treatment.
4.The appearance of cranial and orbital complications.
Second, perioperative treatment
Perioperative treatment is centered on surgery, and in principle should include a series of medication strategies and treatment principles from 1 week before surgery to 3-6 months after surgery. At present, there is a lack of unified standard for perioperative management of nasal endoscopic surgery, and no rigid rules will be made for the time being. Recommendations
The treatment plan is as follows.
1, pre-surgical medication: routine application of antimicrobial drugs, intranasal local and/or systemic glucocorticoids, mucus pro-discharge agents, etc.
2.Post-operative local treatment schedule: regular post-operative cavity cleaning, with follow-up treatment intervals determined after 1 to 2 weeks according to the recovery of the operative cavity for 3 to 6 months.
3.Post-operative drug treatment is the same as the above principles of drug treatment for chronic rhinosinusitis, with anti-inflammatory response medication for not less than 12 weeks.