Chronic sinusitis: an update.

An accurate history is essential to the diagnosis of chronic sinusitis. Patients classically present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, postnasal drip, ear pain or blockage, and fatigue. The headache in chronic sinusitis is usually worse in the morning and following head movement. Purulent nasal discharge, spiking fever, an elevated white blood cell count, and intense, brief headache associated with nausea and vomiting are uncommon. Palpation, transillumination of the sinuses and anterior rhinoscopy are of minimal value in making the diagnosis. Fiberoptic nasopharyngoscopy can be used to identify the source of sinus discharge and the cause of obstruction. Although plain sinus radiographs are useful in diagnosing and monitoring acute sinusitis, they are of limited value in confirming chronic sinusitis. The sinuses are better imaged with computed tomographic scanning. Prolonged antibiotic therapy, in combination with decongestants and steroids, is usually effective for chronic sinusitis. In recalcitrant cases, sinus surgery may be necessary.     

Childhood sinusitis.

Childhood sinusitis is difficult to diagnose. It is classified on the basis of duration of inflammation--acute or chronic--and cause of inflammation--infectious or noninfectious. Infectious sinusitis is often a result of obstruction of the osteomeatal complex. Inflammation in noninfectious sinusitis is similar to the inflammatory changes detected in respiratory mucosa of patients with asthma. Acute sinusitis is primarily an infectious process similar to a prolonged infection of the upper respiratory tract. Plain radiography has limited value for the diagnosis of acute sinusitis in children. The most effective treatment of acute sinusitis is administration of a beta-lactamase-resistant antibiotic. Chronic sinusitis may be infectious, noninfectious, or both. Coronal computed tomography of the sinuses and nasal endoscopy are the preferred methods for determining the presence of chronic sinusitis. When physicians prescribe therapy for chronic sinusitis, they need to consider whether the underlying cause is infectious, noninfectious, or both. Treatment of chronic infectious sinusitis is most effective when a beta-lactamase-resistant antibiotic is administered. Chronic noninfectious sinusitis may respond to topically intranasally applied corticosteroids. If medical treatment fails to resolve the disease within 3 months, surgical intervention may be necessary. Finally, although an association between asthma and sinusitis exists, a cause-and-effect relationship has not been established.     

慢性鼻窦炎鼻息肉经鼻内镜鼻窦手术并发症及其防范

目的探讨慢性鼻窦炎鼻息肉经鼻内镜鼻窦手术并发症发生的原因及其防范补救措施。方法采用回顾性分析111例住院病例围术期观察和出院后随访观察,并对并发症防范及补救措施进行评价。结果本组手术并发症总的为10例（9％）。其中术中出血1例（1％）,眶纸板及眶筋膜损发生2例（1．8％）,内直肌损伤导致复视发生1例（1％）,术腔粘连闭塞发生3例（2．7％）,鼻中隔穿孔发生2例（1．8％）,泪道损伤发生1例（1％）;本组没有其他严重手术并发症的发生。结论鼻内镜鼻窦手术（FSS）并发症在临床上并不少见,应高度重视;严格筛选手术适应证,规范化的围术期用药和处理,术前仔细检查患者和阅读CT片,术后定期随访,适时采取补救措施,对降低手术并发症的发生和保障医疗安全十分重要。     

Managing sinusitis in children

Because of the prevalence of upper respiratory tract infections (URIs), sinusitis is a condition commonly encountered in the pediatric population. Some 5% to 10% of children with URIs also have sinusitis. A thorough clinical evaluation enables the health care provider to accurately diagnose sinusitis in children without overuse of computed tomography scans or antibiotics. This article discusses the diagnosis and treatment of acute sinusitis in children.     

鼻内镜下手术治疗鼻窦炎的疗效分析

目的 探讨鼻内镜下手术治疗鼻窦炎的临床疗效和并发症情况.方法 选取该院2005年5月～2008年5月收治的89例慢性鼻窦炎鼻息肉患者,行鼻内镜手术,回顾性分析其临床治疗情况.结果 随访结果显示全组总有效率为91.0%,共发生3例严重并发症,占3.4%.结论 鼻内镜手术治疗慢性鼻窦炎具有较好疗效,彻底清除病变是关键,术后定期随访能提高治愈率、减少并发症.     

Suppurative (bacterial) sinusitis

Upper respiratory tract (viral) infection is the most common predisposing cause of suppurative sinusitis. Acute disease is manifested by pain, nasal discharge, systemic manifestations, and nasal obstruction. In chronic disease (greater than 3 months' duration) nasal airway obstruction and postnasal discharge may be the only symptoms. Diagnosis is made on the basis of the history and physical examination, supported by roentgenographic findings and, if necessary, cultures. Acute infection is treated with antibiotics, decongestants, and analgesics. If medical management fails, surgery is necessary. Complications of suppurative sinusitis include cellulitis, abscess, meningitis and cavernous sinus thrombosis, osteomyelitis, and oroantral fistula.     

Diagnosis and treatment of sinusitis

Maxillary and ethmoid sinusitis may occur at any age. Frontal sinus infections first appear in adolescence. The bacteria that cause sinusitis are similar to those associated with otitis media. Streptococcus pneumoniae and Hemophilus influenzae are recovered from 50 to 70 percent of isolates. Anaerobes are also important pathogens in adults. Fungal sinusitis usually occurs only in diabetics or immunosuppressed individuals.     

Thunderclap headache from complicated sinusitis

We report a case of complicated pansinusitis presenting with thunderclap headache. The patient quickly developed left ophthalmoplegia and imaging demonstrated extension of inflammation from the sphenoid sinus into the sellar region. Thunderclap headache is well known to occur from a variety of intracranial events, but complicated sinusitis presenting this way is seldom described. The patient recovered completely with appropriate treatment.     

鼻内镜手术治疗慢性鼻窦炎的临床疗效及其与临床分型的关系

目的探讨鼻内镜手术治疗慢性鼻窦炎的临床疗效及其与临床分型的关系。方法回顾性分析2003年10月～2009年8月行手术治疗的219例慢性鼻窦炎患者的临床资料,行鼻内镜手术治疗110例(内镜组)、行传统手术治疗109例(传统手术组)。术后6个月评价临床疗效,随访1年观察复发率。结果内镜组临床疗效总有效率显著高于对照(χ2=3.285,P<0.05)。Ⅰ、Ⅱ型的总有效率显著高于Ⅲ型(χ2=3.443,3.260,P<0.05),Ⅰ型和Ⅱ型的总有效率比较差异无显著性(χ2=2.337,P>0.05)。Ⅰ型治愈率显著高于Ⅱ型、Ⅲ型(χ2=3.689,5.993,P<0.05),Ⅱ型治愈率显著高于Ⅲ型(χ2=4.397,P<0.05)。内镜组术后复发率低于传统手术组(χ2=9.538,P<0.05)。结论鼻内镜手术治疗慢性鼻窦炎临床效果好,术后复发率低;临床分型越重,疗效越差。应根据不同的临床类型采取积极和规范的早期干预。