(September 11, 2018 Dr. Tsang has a question and answer session)

Sinusitis is an inflammation of the mucous membranes of the sinuses and is one of the most common diseases in ENT. Many people suffer from sinusitis, which is not a fatal disease but significantly affects the quality of life.

Sinusitis can be categorized into acute sinusitis and chronic sinusitis, which mainly manifests itself in symptoms such as nasal congestion, runny nose, nosebleed, olfactory impairment, local pain and other symptoms when attacked, accompanied by systemic symptoms such as chills and fever, irritability, peripheral discomfort, loss of appetite, constipation, insomnia, mental depression and so on.

What medication can be used to relieve or cure sinusitis?

I. Acute sinusitis

Generally, non-surgical treatment is the mainstay, and with systematic medication, it is completely curable and does not leave significant mucosal damage.

① Anti-infection:Sensitive antibiotics can be used for adequate treatment in the early stages of an acute attack. The causative organisms of acute sinusitis are mostly Streptococcus pneumoniae, Streptococcus hemolyticus, Staphylococcus, etc. Therefore, penicillin antibiotics can be preferred, such as amoxicillin clavulanate potassium and piperacillin sodium tazobactam sodium. Before using antibiotics, it is best to do bacterial culture and drug sensitivity test, according to the results of drug sensitivity to choose sensitive antibiotics, which can speed up the recovery;

② Nasal ventilation:If patients with severe nasal congestion can be used to reduce nasal mucosal congestion at an early stage, such as furosemide nasal drops, so that the swelling of the nasal mucosa, to achieve the role of ventilation and drainage. It is worth noting that fumar drops can not be used for more than a week to avoid the emergence of drug rhinitis;

③ Clear nasal secretions:Oxytocics such as eucalyptus-pinocampus enteric capsules and nasal care solutions such as physiologic seawater nasal spray may be used;

④ Pain relief:If the patient has a significant headache can be used in conjunction with sedative painkillers to reduce symptoms.

II. Chronic sinusitis

Chronic sinusitis is more common and more complicated in patients, and is caused by acute sinusitis that is not cured and is delayed for more than 3 months. The treatment effect is also relatively poor. Many patients think that once the chronic sinusitis is a lifelong disease, can never be cured, in fact, chronic sinusitis is difficult to treat the root cause is that the patient did not carry out systematic standardized treatment.

①Anti-inflammatory treatment:Glucocorticoids have anti-inflammatory and decongestive effects，Nasal spray treatment with such hormones (e.g., mometasone furoate nasal spray, budesonide nasal spray, etc.) is available. Because of the small dose of hormone used in a single application, there are almost no systemic side effects;

② Antimicrobial therapy:Penicillin, cephalosporin, and quinolone antibiotics are mostly used in patients with acute exacerbations of chronic sinusitis, or with septic complications;

③ Reduce nasal mucosal congestion:If symptoms of severe nasal congestion are present, consider short-term use of a decongestant such as furosemide nasal drops, usually for no more than 7 days;

④ Systemic antihistamines:For patients with frequent sneezing, itchy and tearful nose, antihistamines such as loratadine can be taken orally at the same time to reduce the symptoms;

⑤ Mucosal pro-excretory agents:It can dilute the nasal mucus and improve the ciliary activity, promote the discharge of secretion, the drug can be used eucalyptus pinocampus enteric soft capsule;

(vi) Chinese medicine:Herbal medicines such as nasal abyss soft capsules and rhinitis tablets are effective in improving the symptoms of sinusitis.

(vii) Nasal rinsing:For example, physiological seawater nasal spray can clear nasal secretions, reduce the inflammatory state of the nasal cavity, reduce mucosal edema, and promote the recovery of nasal mucosal cilia function.

Chronic sinusitis treatment course is generally 3 months, after the above standardized treatment most patients can get significant improvement, hope that patients with chronic sinusitis to adhere to, regular treatment, in order to achieve significant relief of sinusitis symptoms, and even cure sinusitis.

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When many people hear about sinusitis as a disease, they subconsciously think that it is troublesome and generally difficult to cure. In clinical work, there are also many patients who say, "Doctor! I have sinusitis, how to treat?" . When the doctor asks, "What tests have you done? In what medical structure examination diagnosed as sinusitis?" , the patient replies, "It's just a stuffy, runny nose, went to the clinic and the doctor said it was sinusitis." There are also some patients who have had sinusitis once before, and have a kind of inertia in its psyche, so they think they have always had sinusitis. Sinusitis current diagnosis of the best method, is the sinus CT examination.

In fact, sinusitis is a very common disease, many people have had, and some patients have had sinusitis, sinusitis well, they are not clear. Sinusitis has acute sinusitis and chronic sinusitis, acute sinusitis is acute inflammation of the nasal cavity, that is, acute rhinitis (cold), causing blockage of the sinus openings, causing poor sinus drainage, causing sinus inflammation.Acute sinusitis treatment isEmphasize the selection of sensitive antibiotics and their use in adequate amounts and courses. If the headache or localized pain is severe, sedatives or analgesics can be used appropriately. General therapy is the same as acute rhinitis (cold). With some vasoconstrictor drugs, theImprove sinus drainage. Oral mucus-thinning pro-drainage agents to thin mucus and promote drainage. Nasal spray glucocorticoids to reduce sinus opening edema. Sinus puncture drainage therapy and sinus replacement therapy.

Chronic sinusitis is considered when acute sinusitis remains untreated for more than twelve weeks.Chronic sinusitis treatment is indeed tricky to treat, but standardized treatment is quite effective. Its standardized treatment, first of all, is antibiotic treatment, which is recommended to considerLong-term low-dose macrolide antibiotic therapy is effective. Nasal spray glucocorticoids reduce nasal edema and promote sinus opening. Oral mucus-thinning pro-discharge agents with antihistamines. It can also be treated with some Chinese medicine, which advocatesAromatic pass through the orifices, clearing heat and removing toxins, removing dampness and draining pus as the principle. If the effect is not satisfactory through conservative treatment for more than three months, it is recommended to do sinus CT examination, nasal endoscopy, and consider surgical treatment, now functional nasal endoscopy surgery, the effect is quite good!

Sinusitis is a very stubborn disease that usually starts with rhinitis, which is prolonged and develops into the sinuses. The medical definition of sinusitis is inflammation of the mucous membrane of the sinuses, mostly caused by viruses or allergies. Cure sinusitis need to do the following two points: First, the full course of medication

Second, do not blindly use drugs, the condition of different drug selection is different

Learn more about it below:

I. Typing

According to the course of the disease, sinusitis can be divided into: acute <4周，亚急性4-12周，慢性>12 weeks

(ii) Pathogens

1. Acute sinusitis:

Streptococcus pneumoniae (33%)

Haemophilus influenzae (32%)

Rhinovirus or other viruses (15%)

Rare: Pseudomonas aeruginosa (10%), anaerobes (6%)

2. Chronic sinusitis:

streptococcus pneumoniae

hemophilus influenzae

Pseudomonas aeruginosa

multicolony infection

Increase in gram-negative bacterial infections

anaerobic bacteria

Third, the choice of drugs: Although sinusitis is usually caused by viruses, there is no need to routinely use antiviral drugs

allopathic medicine

1. Acute sinusitis:

①Local decongestants: Seroquelin hydrochloride nasal spray, 2-3 sprays/times on 1 side, once in the morning and once before bedtime. Suitable for people with runny nose

②Antihistamines: loratadine 10 mg orally once a day; fluticasone: 2 sprays/per nostril once a day; azelastine: topical use only

③ Analgesics: acetaminophen, ibuprofen or other NSAIDs

2. Chronic sinusitis: same as acute sinusitis

antimicrobial

Indications for the use of antimicrobials, as long as one of the following three is met:

(i) Nasal discharge + severe symptoms; (ii) Nasal symptoms lasting more than 10 days; (iii) Worsening of the condition during the 7 days with symptoms

1. Acute sinusitis:

Preferred:

① Amoxicillin 0.5-1.5g, orally, 3/day for 10-14 days;

(ii) Amoxicillin/clavulanic acid 875/125 mg orally 2/day for 10 to 14 days;

(iii) Cefuroxime 250 mg orally 2 times/day;

④ Cefdinir 300mg orally 1x/12h;

⑤ Cefprozil 250-500mg, orally, 2 times/day

Alternative (for those allergic to penicillins):

(1) Azithromycin 0.5g, orally, once/day for 3 days; (2) Clarithromycin 0.5g, orally, twice/day for 14 days. Clindamycin is usually ineffective.

If none of the above drugs are effective, choose levofloxacin 0.5g, orally, 1 time/day (prohibited under 18 years old)

2. Chronic sinusitis

Drug species selection is the same as acute sinusitis, the course of treatment 3 to 6 weeks. The specific dosage of the drug is as follows:

Preferred: amoxicillin clavulanic acid 875/125mg orally 1x/8h

Alternative:

(1) Cefuroxime 500 mg orally 2 times/day;

② Cefprozil 500 mg orally, 2 times/day;

(iii) Clarithromycin 500 mg orally 2 times/day;

④ Levofloxacin 500mg orally 1x/day;

⑤ Clindamycin 300mg, oral, 1x/8h

The above is for reference only, not for medical prescription, the discomfort please go to the regular hospital, follow the doctor's instructions for medication.

Good luck with your health!

References:

1. ABX Guidelines for the United States

2. Sanford's Fever, 42nd ed.

Drugs.com authoritative interpretation, unauthorized reproduction, plagiarism will be prosecuted

There are 4 pairs of sinuses, the maxillary, sieve, frontal and pterygoid sinuses. Inflammation of the sinuses is called sinusitis, which refers to inflammation of the mucous membranes of the sinuses, and sinusitis usually coexists with rhinitis. The occurrence of sinusitis is related to its own anatomical characteristics, the sinus drainage position of the high and low, the straightness and narrowness of the cavity will affect the drainage of the sinuses, drainage is poor, it is easy to inflammatory reaction.

There are two types of sinusitis: acute and chronic. Acute sinusitis is mostly a purulent or catarrhal inflammation.Treatment is based on the application of antibiotics to reduce inflammation, enhance nasal drainage, application of mucus dissolver (eucalyptus pinene enteric soft capsule) to dilute and dissolve secretions so that they can be discharged more easily, in addition to the option of nasal rinses, rinsing 1-2 times a day to promote drainage.

Chronic sinusitis is due to acute sinusitis repeated episodes are not completely cured and delayed due. Chronic sinusitis can be treated conservatively, the treatment is basically the same as acute sinusitis.For those who have chronic sinusitis that does not respond to conservative treatment, surgery needs to be considered.

Therefore, for your kind of frequent sinusitis reflux to the throat, not only suffer from the pain of sinusitis, but also repeatedly suffer from laryngitis, it is recommended that you should be actively treated for yellowish pus nasal mucus, suggesting that there is still a bacterial infection.

Sinusitis is an inflammation that occurs in one or more sinuses. The cumulative sinuses include the frontal, maxillary, sieve and pterygoid sinuses. According to the course of the disease is acute ( <12周）和慢性（>12 weeks). The main manifestations are local symptoms such as nasal congestion, pus, headache, decreased sense of smell and systemic symptoms such as fever. Sinus CT is currently a good indicator for the diagnosis of acute and chronic sinusitis.

The title emphasizes recurrent pus and snot, but does not mention the time of onset. So, let's talk about the treatment of acute and chronic sinusitis.

Acute sinusitis:

1, anti-infection: antibiotics preferred penicillin, cephalosporin, such as amoxicillin clavulanate potassium, cefuroxime. Those who are allergic to penicillin can consider macrolides (azithromycin, clarithromycin) or fluoroquinolones (levofloxacin). Emphasize: use sensitive antibiotics and administer them in adequate doses and regimens.

2、Hormones: can be applied locally or systemically, such as budesonide nasal spray. Today's headline - Dr. Zhang, Department of Integrative Medicine

3, symptomatic treatment: pain can be given ibuprofen or acetaminophen sedation and analgesia; nasal congestion can be applied to furosemide nasal drops (not more than a week) to reduce nasal mucosal congestion and edema; mucus secretion can be given oral amphetamine-pinocamphe enteric capsule and physiological seawater nasal spray nasal wash; sneezing, runny can be anti-histamine treatment, such as oral loratadine.

4, Chinese medicine treatment: to dispel wind and clear heat, aroma and pass the main.

Most acute sinusitis resolves in a short period of time with reasonable medication.

Chronic sinusitis:

Most of the transformation from acute sinusitis, treatment has a lot in common. The root cause of chronic sinusitis is that it is not treated in a systematic and standardized way. Note: Chronic sinusitis traditional Chinese medicine treatment to aroma through the orifices, clearing heat and detoxification, eliminating dampness and pus as the principle, such as nasal abyss tablets, rhinitis tablets, and so on.

The course of conservative treatment for chronic sinusitis is usually 3 months, after standardized treatment most of the patients' symptoms can be significantly improved, or even cured. If the efficacy is not satisfactory, it is recommended to do sinus CT examination, if there are imaging changes and surgical indications, feasible nasal endoscopic surgery.

To emphasize, acute and chronic sinusitis drug application and surgical treatment should be carried out under the guidance of a professional doctor, do not take medication without authorization to avoid damage to health.

First of all, it is important to note that many people suffer from sinusitis, just that many people do not have any special discomfort. In my clinic, I give patients cranial CT or MRI examination, the report suggests that many people have sinusitis.

Secondly, chronic inflammation is very difficult to cure completely, so we must kill the inflammation completely in the acute stage, once it is more than 2-3 months, it becomes chronic inflammation, which is basically very difficult to be cured.

Furthermore, if there is no special discomfort, no special treatment or management may be necessary.

Finally, Western medicine is generally not a good way, unless the sinusitis is very serious, or even combined with nasal polyps and so on has affected the normal life, before considering surgery. Therefore, if you need medical treatment, or to traditional Chinese medicine treatment, Chinese medicine is still the lung, spleen and qi deficiency as the root, and there are a lot of through the nose of the Chinese medicine, the effect is very good (specific need for Chinese medicine specialists to identify the doctor, please pay attention to my public number).

Sinusitis is clinically categorized into acute sinusitis and chronic sinusitis, which is a kind of multiple nasal diseases. The treatment of sinusitis is mostly standardized, but it should also be handled according to the patient's own situation and specific symptoms. If there is a lot of pus in the nasal cavity, physiological seawater can be used to rinse the nasal cavity, with local medication. Antibiotics such as macrolide antibiotics and antiviral drugs are also prescribed to reduce inflammation and prevent infection. It may also be necessary to take oral mucus promoters, Chinese medicines for sinusitis, the treatment is more effective. Chronic sinusitis usually takes a long time to treat, and treatment must be patient to prevent recurrent infections.

It is recommended to use medication under the guidance of the doctor, if there is a worsening of symptoms, go to the hospital in a timely manner. Usually pay attention to personal hygiene, prevent cold and warmth, prevent colds and flu, enhance physical fitness, prohibit smoking and alcohol, usually eat a light diet, eat more fruits and vegetables, eat less spicy and stimulating fried food, improve their own immunity. Take your medication on time to avoid interruption of the treatment effect and lengthen the treatment process.

To learn more about ear, nose and throat, please follow my headline [ENT doctor Li Xia].

Inflammatory changes in the sinus mucosa are known as sinusitis. Because the mucous membranes of the nasal cavity and sinuses are continuous with each other, inflammation of the mucous membranes of the sinuses is usually accompanied by inflammation of the mucous membranes of the nasal cavity, which is often referred to as rhinitis.

There are acute and chronic sinusitis, and chronic sinusitis is the most common in clinical practice. The principle of treatment for both is basically the same, that is, to relieve the nasal sinus drainage and ventilation obstacles. Acute sinusitis and chronic sinusitis acute attack will generally have systemic symptoms, such as fever, chills, etc., at the same time there will be a severe headache, and the location of the headache due to the different sinuses and different, for example, acute maxillary sinus eye is generally the supraorbital frontal headache, can also be accompanied by maxillofacial pain, etc.; Acute sieve sinus headache is generally lighter, usually in the inner canthus of the eye or the root of the nose; and the acute frontal sinusitis pain is located in the forehead, especially the brow ridge. The headache is usually mild, usually at the inner canthus of the eye or at the root of the nose; whereas acute frontal sinusitis pain is located in the forehead, especially at the brow ridge.

Both acute sinusitis and acute episodes of chronic sinusitis require adequate antibiotics to control infection and prevent complications. If pus is extracted after maxillary sinus puncture, a secretion culture should be done to clarify the causative organism and select a sensitive antibiotic. If the causative organism cannot be clarified, broad-spectrum antibiotics need to be selected. Topical treatment may include glucocorticoids or intranasal decongestants (not to be used for more than 7 days), and may be supplemented by nasal irrigation to help clear nasal secretions. In addition, maxillary sinus puncture irrigation is a common treatment for maxillary sinusitis. If sinusitis is accompanied by nasal polyps, etc., it should be treated surgically; if conservative treatment is ineffective, then surgery is also needed to open the sinus openings and clear the lesions to help restore ventilation and drainage of the nasal cavity and sinuses.

Respondent: Ping Zhang, M.S.

Welcome to Life Calling for more useful health knowledge.

Acute sinusitis:Most of the acute sinusitis is caused by bacterial infection, generally can be given to patients with antibiotic treatment, antibiotic treatment time generally need one to two weeks, commonly used antibiotics are macrolide antibiotics, cephalosporin antibiotics, you can also give the nose local drops, drops of blood-reducing rinse, can play a vasoconstriction, to improve the ventilation function of the nasal cavity, but this type of drug should not be used for a long time, so as not to cause drug-related Rhinitis, at the same time you can use physiological salt nasal wash, can promote the discharge of nasal secretions.

Chronic sinusitis:For chronic sinusitis, antibiotics are required for a longer period of time as compared to acute sinusitis, which can also be treated with nasal sprays, or if the sinusitis is found to be caused by a mold infection, antibiotics are not required for treatment.

Sinusitis patients should be reasonable use of drugs, if the treatment treatment is ineffective, you can do sinus CT, nasal endoscopy, drug treatment is ineffective then you need surgical treatment, commonly used surgical treatment modalities are endoscopic sinus surgery, maxillary sinus radical surgery.

Sinusitis is an inflammation of the mucous membranes of the nasal sinuses. To understand sinusitis, you first need to know what is meant by sinus.

In the human body around the nasal cavity, there are four pairs of cavities, these four pairs of cavities are distributed around the nasal cavity, with the nasal cavity is connected, usually because of the skin and bone cover, we can not see these cavities, but if you do a CT scan can be seen, on the distribution of the nasal cavity around the four pairs of cavities, these cavities, we call the sinuses.

See, that's pretty much it. Those are the sinuses up there.

When a bacterial infection occurs in the mucous membranes inside the sinuses and there is inflammation, the mucous membranes will secrete a lot of mucus, and the accumulation of this mucus will aggravate the inflammation, and some of the mucus will flow out and enter the nasal cavity, forming snot, and because of the accumulation of this mucus inside the sinus cavities, it leads to an increase in pressure inside the sinuses, which can cause pain.

It's a sinus infection.

How is it treated?

1, antibiotics: when the occurrence of acute sinusitis, must use a sufficient amount of antibiotics, because most of the sinusitis is a bacterial infection, so the use of antibiotics is very necessary, and the dose should be enough, the purpose is to prevent the acute sinusitis into a chronic, such as the use of cefradine, cefazolin, amoxicillin and so on, antibiotics, if it is clear that the anaerobic bacterial infection, you can use metronidazole.

2, intranasal decongestant: in addition to the use of antibiotics, the use of intranasal decongestant is also very important, such as ephedrine nasal drops, can shrink the nasal mucosa, relieve edema, reduce symptoms.

3、Positional drainage: If the sinuses secrete more fluid, it must be positional drainage, the purpose is to flow out the fluid inside the sinuses, in order to better control the inflammation.

4, physical therapy: you can local hot compresses, with hot towels in the sinuses above, plus promote local blood circulation, reduce symptoms.

5, nasal rinsing: this is very important, inexpensive method. You can use a syringe or a special nasal rinse, the rinse solution can be saline, or with some antibiotics, such as gentamicin, metronidazole, etc., you can also use a little hormone, such as dexamethasone, are to reduce inflammation, reduce edema with.

6, maxillary sinus puncture rinse: some sinus inflammation is very serious, there is no way to drain the secretion, then you can directly use a needle to puncture the sinus, the mucus out, with saline rinse, and then in the injection of antibiotics. Some patients can be cured with one rinse, but others may need repeated rinses.

Acute sinusitis can usually be controlled after the above treatment. If the treatment is not effective, it may cause the condition to recur and develop into chronic sinusitis, which will be more difficult to cure completely.