UT-Southwestern Medical Center, Department of Otolaryngology-Head and Neck Surgery, Dallas, TX 75390-7208, USA.
Postgrad Med. 2009 Nov;121(6):121-39. doi: 10.3810/pgm.2009.11.2081.
Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination.
慢性鼻-鼻窦炎（CRS）的特征为鼻腔和鼻旁窦黏膜炎症；其病因可能为数众多、各不相同且常相互重叠。更常见的与 CRS 相关的病症包括常年性变应性和非变应性鼻炎、鼻息肉和解剖学机械性阻塞（鼻中隔/鼻甲问题）。其他不太常见的病因包括炎症（例如，由超抗原引起的炎症）、真菌性鼻窦炎或细菌性鼻窦炎伴或不伴生物膜形成、胃食管反流、烟雾和其他环境暴露、免疫缺陷、遗传和阿司匹林加重的呼吸道疾病。如果症状（例如，充血和/或饱满感；鼻塞、阻塞、分泌物和/或脓性分泌物；变色的后鼻分泌物；嗅觉减退/丧失；面部疼痛和/或压力）及其持续时间>3 个月，则强烈提示患有 CRS。明确诊断需要在体格检查期间发现黏膜肿胀或分泌物的物理证据，并且如果炎症不涉及中鼻甲或筛泡，则需要 CT 成像。多变量病因使得 CRS 的诊断和治疗选择变得复杂。此外，包括耳鼻喉科专家、过敏症专家、初级保健医生和肺病专家在内的各种类型的医疗保健提供者治疗 CRS，并且每个人可能都有不同的方法。对 CRS 的诊断和管理进行结构化处理可以帮助简化和标准化护理，无论患者在哪里接受评估和治疗。由美国耳鼻喉过敏学会（AAOA）支持的 2008 年成人 CRS 工作组根据对 CRS 作为炎症性疾病的不断发展的理解，制定了一系列成人 CRS 鉴别诊断和治疗的算法。本文介绍的算法涉及所有 CRS 患者的治疗方法，以及涉及鼻息肉、鼻内镜下观察到的水肿、鼻内镜下观察到的脓性分泌物、异常病史和体检以及异常病史和正常体检的患者的治疗方法。
