What is Chronic Sinusitis?

Chronic sinusitis is a chronic purulent inflammation of the sinuses. More common than acute cases, often involving multiple sinuses at the same time. Chronic sinusitis affects the patient's quality of life, worsens the symptoms of respiratory infections in patients, and severe cases may cause craniocerebral pulmonary complications, cause vision changes, and even worsen infections and die. Most patients with chronic sinusitis can be cured with medication and surgery. A few patients with specific constitutions such as allergies, asthma, and aspirin intolerance often have recurrent attacks.

Basic Information

English name: chronic sinusitis
Visiting department: Otorhinolaryngology head and neck surgery

Multiple groups: Young, old and infirm
Common causes: Improper or incomplete treatment of acute sinusitis
Common symptoms: Purulent nose, stuffy nose, headache, chronic pharyngitis, etc.

Causes of chronic sinusitis

Acute sinusitis

Mostly due to improper treatment of acute rhinosinusitis or incomplete treatment of it, recurrent attacks occur, the delay is not healed, and it becomes chronic. This is the primary cause of this disease.

2. Obstructive etiology

Obstructive diseases in the nasal cavity, such as nasal polyps, turbinate hypertrophy, nasal stones, deviated nasal septum, nasal tumors, and nasal tampons, impede nasal and sinus ventilation and drainage, which are important causes of this disease.

3. Strong pathogenic bacteria

Some of the more virulent pathogens, such as type B hemolytic streptococcus when suffering from scarlet fever, can cause chronic sinusitis easily.

4. Dental infection

Because the roots of the upper molars are adjacent to the base of the maxillary sinus, if the tooth disease is not cured, it is likely to become chronic dental maxillary sinusitis.

5. Trauma and foreign bodies

Such as trauma fractures, foreign body retention or blood clot infection, etc., lead to chronic sinusitis.

6. Anatomical factors of sinuses

Due to the special or abnormal anatomical structure of each sinus, it is not conducive to ventilation and drainage, and is also a factor that cannot be ignored.

7. Systemic factors

Including various chronic diseases, malnutrition, fatigue and low body resistance. At the same time, there are various allergic factors and the causes caused by bronchiectasis.

Clinical manifestations of chronic sinusitis

1. good group

All populations are prone to occur, and younger, older and infirm are more common.

2. Symptoms of the disease

(1) Local symptoms Purulent snot: Most of the nasal discharge is purulent or mucopurulent, yellow or yellow-green, the amount is uncertain, and it can flow back to the pharynx. Those with unilateral odor are more common in odontogenic maxillary sinusitis or Fungal infection. nasal congestion: ranging from severe to severe, mostly due to nasal congestion and swelling and increased secretions. Olfactory disorders: nasal congestion and inflammatory reactions can lead to olfactory disorders. headache: chronic sinusitis generally does not have obvious local pain or headache. If you have a headache, it usually manifests as dull pain or a heavy head. It is heavy during the day and light at night. Sinusitis in the anterior group mostly showed swelling or stuffiness in the forehead and root of the nose, and headache in the posterior group was at the top of the head and posterior pillow. Suffering from dental maxillary sinusitis, often accompanied by ipsilateral upper tooth pain. Others: As pus flows into the pharynx and breaths through the mouth for a long time, it is often accompanied by chronic pharyngitis symptoms such as excessive phlegm, foreign body sensation, or dry throat pain. If it affects the eustachian tube, tinnitus, deafness and other symptoms may also be present.

(2) Other symptoms: A sense of pressure on the eyes can cause visual impairment, but it is rare. The head feels heavy pressure, or there is only dull or stuffy pain.

(3) Systemic symptoms are milder or inconspicuous. Generally, they may have symptoms such as dizziness, fatigue , depression, malaise, poor appetite, insomnia, memory loss, inattention, and reduced work efficiency. Very few cases may have persistent low fever if they have become lesions.

3. Disease hazards

Affect the patient's quality of life, aggravate the symptoms of respiratory infections in patients, severe cases may cause craniocerebral pulmonary complications, cause vision changes, and even exacerbate the infection and die.

Chronic sinusitis examination

Nasal examination

The lesions mainly consisted of changes in the upper nasal cavity, showing edema or hypertrophy in the middle turbinate, and even polyp-like changes. Some can see multiple polyps. Sinusitis in the anterior group showed sticky purulent secretions attached to the surface of the middle nasal passage and inferior turbinate. Sinusitis in the back group showed olfactory fissures and mucopurulent deposits in the back of the middle nasal passage. In severe cases, purulent discharge was seen in the nasopharynx.

2. Auxiliary inspection

(1) Nasal endoscopy is anterior and posterior nostril examination. The nasal mucosa is contracted with ephedrine, and then all parts of the nasal cavity are examined carefully. Edema, pus or polyps are visible.

(2) Postural drainage examination is possible when chronic sinusitis is suspected and no pus remains in the middle nasal passage or olfactory fissure.

(3) Maxillary sinus puncture and irrigation Maxillary sinus puncture and irrigation is both a diagnostic method and a treatment measure for maxillary sinusitis. The effluent should be used for aerobic bacterial culture and drug sensitivity.

(4) X-ray sinus radiography can assist in diagnosis if the diagnosis is not clear or if other lesions are suspected.

(5) Examination of teeth In the case of suspicious odontogenic maxillary sinusitis, a special examination of the teeth should be performed.

(6) CT diagnosis of sinuses CT of sinuses is helpful for clarifying the extent of lesions, identifying local bone changes, and distinguishing them from nasal tumors. Because of its higher resolution, CT is more detailed and comprehensive in observing lesions, which is a good indicator for the diagnosis of chronic sinusitis.

(7) MRI of the sinuses MRI has a good discrimination between soft tissues and fluids in the sinuses, and it is beneficial to develop a complete surgical plan before surgery.

Diagnosis of chronic sinusitis

Diagnosis can be made based on the etiology, typical symptoms, and sinus CT examination.

Differential diagnosis of chronic sinusitis

It is mainly distinguished from other diseases that cause headaches, such as migraine and intracranial tumors; due to nasal congestion, it must be distinguished from nasal cavity and sinus tumors, such as nasal papilloma and nasal squamous cell carcinoma. Pathological diagnosis can be clear.

Chronic sinusitis complications

Eye complications

Orbital bone wall osteitis, periostitis, suborbital abscess, orbital cellulitis, intraorbital abscess, retrobulbar optic neuritis.

2. Intracranial complications

Epidural abscess, subdural abscess, suppurative meningitis, brain abscess, cavernous sinus thrombophlebitis.

Chronic sinusitis treatment

Antibiotic

Although macrolide antibiotics cannot eliminate bacteria, they can reduce the toxicity of chronic bacterial infections and reduce cell damage. In cases of hormonal failure, selective long-term low-dose macrolide antibiotics are effective. The specific mechanism of action is not very clear, but may be related to the down-regulation of the local host's immune response and the weak toxicity of reproduction bacteria

Vasoconstrictor

Can shrink the swollen mucosa of the nasal cavity to facilitate sinus drainage. However, vasoconstrictor should not be used for a long time, it will cause secondary drug rhinitis.

3. Mucus drainage promoting agent

Adding mucus excretion enhancer to the standard treatment method can get better treatment effect, mainly can reduce the treatment time.

4. Antihistamines

Although antihistamines are not recommended for the treatment of chronic rhinosinusitis, a study in the United States shows that antihistamines are often used in the treatment of chronic rhinosinusitis, which can significantly reduce sneezing , Runny nose and stuffy nose, but it has no significant effect on the size of nasal polyps.

5. Hypertonic saline

Hypertonic saline can improve the cilia clearance of nasal mucosa, and clinical trials have shown that hypertonic saline has obvious effects in various evaluation indicators of cough, runny nose, and postnasal drip syndrome.

6.Physiotherapy

Ultrashort wave diathermy is generally used to assist treatment.

7. Sinus Replacement

Sinus replacement. Suitable for multiple sinus inflammation and children.

8. Surgical treatment

(1) Endoscopic sinus surgery is currently the preferred method. Under clear vision of the nasal endoscope, the sinus lesions are completely removed, the sinus openings are fully opened, the sinus drainage is improved, and the normal tissue is preserved as much as possible. It is a minimally invasive operation that retains the function as much as possible.

(2) Other operations: Maxillary sinus intranasal fenestration, maxillary sinus radical surgery, intranasal ethmoidectomy, extranasal ethmoidectomy, frontal sinus drilling, frontal sinusotomy, sphenoidotomy .

For a patient with confirmed chronic sinusitis, the recommended treatment procedure should be: first drug treatment (including local and systemic application), CT scan of the sinuses if the drug treatment fails, if there are imaging changes and surgical indications, Then perform nasal endoscopic surgery.

Prognosis of chronic sinusitis

Most patients can be cured by drugs and surgery. A few patients with allergies, asthma, aspirin intolerance and other specific constitutions often have recurrent attacks.

Prevention of chronic sinusitis

1. Strengthen physical exercise, enhance physical fitness, and prevent colds.

2. Acute rhinitis (cold) and dental disease should be actively treated.

3. Don't blow your nose hard when there is secretion in the nasal cavity, you should block the nostril on one side and clean the nasal secretion on the other side.

4. Timely and thorough treatment of acute inflammation of the nasal cavity and correction of anatomical deformities of the nasal cavity, treatment of chronic rhinitis and nasal septum deviation.

5. Avoid diving and snorkeling when swimming.

6. When suffering from acute rhinitis, it is not advisable to fly.

7. Properly treat allergic diseases and improve nasal cavity and sinus ventilation and drainage.

Notes on chronic sinusitis

1. During autumn and winter or cold epidemics, you should wear a mask when going out, avoid public gatherings, go to public places as little as possible, isolate the affected person, and use white vinegar fumigation for air disinfection in the polluted room.

2. Rhinitis is mostly caused by cold and cold, so it is necessary to strengthen physical exercise and strengthen resistance, such as morning jogging, swimming, cold water bath, cold face washing, etc. can enhance physical fitness and improve the body's tolerance to cold.

3. Sinusitis daily life precautions should avoid excessive fatigue, lack of sleep, cold, smoking, drinking, etc., because these factors can reduce the body's resistance, resulting in poor nasal mucosal regulation, the virus multiplies and causes disease.

4. Maintain the humidity of the indoor air or use an air filter. Do not let the nose be too dry. Replace and clean bedding in time to prevent mites and their secretions from allergic rhinitis.

5. Patients with sinusitis can often do nasal massage. Pay attention to the method of blowing the nose. Those with nasal congestion and nasal discharge should press the nostril on one side and squeeze the external force slightly, then alternately and belching. When the nose is too thick, wash the nose with saline. Injury to the nasal mucosa.

6. Patients with sinusitis need to take medication in a timely manner according to the doctor's advice. Patients with chronic sinusitis should have confidence and perseverance, maintain a cheerful temperament, and avoid irritation in spirit. At the same time, pay attention not to overwork, and strengthen exercise to enhance physical fitness.

7. During an acute episode of sinusitis, take more rest. The bedroom should be bright and keep indoor air flowing, but avoid direct blowing and direct sunlight.

8. When the sinusitis is not cured for a long time, you should consult the doctor for the necessity of surgical treatment. If you undergo surgery, you must follow the doctor's order to review on time to avoid surgical failure and recurrence of the disease caused by untimely review of the surgery.

References

1. Chinese Medical Association Otolaryngology Branch, Chinese Journal of Otolaryngology Editorial Board. Clinical classification and staging of chronic sinusitis and nasal polyps and endoscopic sinus surgery evaluation criteria (1997 Haikou): Chinese Journal of Otorhinolaryngology, 1998: 33 (3): 134.

2. Xu Geng. EPOS-2007 Interpretation. 2008 National Conference on the Diagnosis and Treatment of Chronic Rhino-Sinusitis, 2008, 6-12.