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Suffering from ENT disorders

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Chronic rhinosinusitis (CRS)
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Chronic Rhinosinusitis

 

Chronic rhinosinusitis (CRS) is a prevalent respiratory disease which comprises many forms of disorders. Such disease has a rather complex pathogenic mechanism which is comprised of different contributing factors. Primary risk factors for the development of CRS are viral and bacterial infection of the nasal mucosa and chronic suppurative inflammation of the sinuses. Typical symptoms are nasal congestion, runny nose, anosmia, headache and memory loss, which may aggravate the respiratory tract infection, and may cause cranio-pulmonary complications which often result visual acuity changes.

 

Symptoms

Localized symptoms include: pyogenic nasal mucus which can flow backward to pharynx; nasal congestion: various degrees of symptoms caused mainly by hyperemia and increased secretion of the  nasal mucosa; olfactory disorders: nasal congestion and inflammatory reaction can lead to olfactory disorders; headache: characterized by dull pain or feeling of heaviness on the head; patient with anterior nasosinusitis often report pain on the forehead or the root of the nose, while patients with posterior nasosinusitis commonly experience headache on the vertex or in the occipital region; symptoms of chronic pharyngitis, such as excessive sputum, pharyngeal pain, etc.

 

Causes

The pathophysiology of CRS is multifactorial. The interaction between systemic, local host, and environmental factors contribute to the inflammation of the nasal sinus.

 

• Systemic factors: include genetic diseases such as cystic fibrosis, conditions causing immunodeficiency, autoimmune disease, idiopathic conditions such as Smarters triad (aspirin exacerbated respiratory disease), and acid reflux.

• Local host factors: sinonasal anatomical abnormalities, neoplasm, or the presence of foreign body, among others.

• Environmental factors: presence of biofilms and bacterial infection, as well as fungal infection, allergy, environmental infections, and smoking.

• Acute sinusitis: improper, ineffective or incomplete treatment of acute sinusitis could lead to the progressive development of CRS.

• Occlusion in nasal cavity: occlusion-induced disorders, such as nasal polyp, hypertrophic turbinate, nasal cavity calculus, deviation of nasal septum, tumor of nasal cavity, etc, could hinder the air flow and drainage in nasal cavity.

• Virulent bacteria: acute sinusitis caused by virulent bacteria, such as Streptococcus haemolyticus B in scarlet fever, is prone to turn into CRS.

• Adontogenic infection: since the root of the upper molars is adjacent to the bottom of the maxillary sinus, any tooth disease could evolve into CRS.

• External injury: include bone fracture, foreign body retention or clot infection.

• Anatomical abnormality: the anatomical structure has a direct bearing on the ventilation in the nasal cavity.

• Systemic factors: include a variety of chronic diseases, as well as malnutrition and fatigue which leads to the decline in the immune system.

    

Diagnosis

 

• Nasal cavity examination

   Such examination aims to identify if there is any disorder in the upper nasal cavity. Targeted symptoms include edema and hypertrophy of the middle turbinate and nasal polyps. For patients with anterior sinusitis, mucosuppurative secretion is found on the surface of the middle nasal meatus and the inferior turbinate, while for patients with posterior sinusitis, factory fissure and mucus fluid in the posterior part of the middle nasal meatus, and purulent secretion in the nasopharynx in severe cases.

• Auxiliary examinations

Endoscopic examination

Puncture and irrigation of maxillary sinus

CT examination of nasal sinus

X-ray test

MRI examination of nasal sinus

 

Treatment options

 

Conservative Treatment:

         • Medication

​       • Antibiotics treatment: to reduce the toxicity of chronic bacterial infections.

       • Vasoconstrictor treatment: to contract the swollen nasal mucosal membrane, so as to facilitate the sinus drainage. However, long-term use of vasoconstrictor could cause secondary drug rhinitis.

       • Hypertonic saline treatment : to accelerate the clearance of nasal mucosa cilia.

       • Physiotherapy: in general, ultra-short wave diathermy therapy is used as a complementary treatment solution.

 

• Surgical treatment:

Endoscopic sinus surgery (ESS) has become the standard surgical treatment method for CRS patients who do not respond to the maximal medication therapy. It is a kind of minimally invasive surgical method in which the diseased part of the nasal sinus is completely removed under a clear and open view provided by nasal endoscope. During the procedure, the nasal sinus is cut open to the extent that the sinus drainage can be treated normal, without hindering the basic functions of nasal sinus. It has been proved in clinical cases that the ESS achieves the utmost surgical efficacy when it is conducted under the assistance of the low temperature plasma ablation technology.